DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 244 Engrossed 2021 Regular Session Turner
Abstract: Provides for the licensing and regulation of pharmacy services administrative
organizations.
Proposed law defines "pharmacy services administrative organization", "pharmacy services
administrative organization contract", and "clean claim".
Proposed law requires a pharmacy services administrative organization operating within the state of
La. to be registered and licensed with the Dept. of Insurance by submission of an application and
registration fee to the commissioner of insurance. Requires the commissioner's fee to not exceed
$300.00. Further prohibits a pharmacy services administrative organization from entering into an
agreement or contract with a pharmacy if such organization is not registered and licensed by Jan. 1,
2022.
Proposed law provides that a pharmacy services administrative organization is not responsible for
activities solely within the purview of a pharmacy benefits manager. Further requires the
commissioner to promulgate rules to define roles and responsibilities solely within the purview of
pharmacy benefits managers and pharmacy services administrative organizations.
Proposed law requires a pharmacy services administrative organization to notify a contracted
pharmacy in writing of any activity, policy, or practice that presents a conflict of interest. Further
prohibits a pharmacy services administrative organization from engaging in any act, method, or
practice prohibited by present law provisions of Unfair Trade Practices (R.S. 22:1961 et seq.).
Proposed law prohibits a plan sponsor or pharmacy benefits manager from retroactively reducing
payments on clean claims unless certain conditions apply. Provides that if a written agreement
exists, retroactive increases in payment to a pharmacy are allowable. Further requires a pharmacy
services administrative organization to provide a contracted pharmacy with access to the pharmacy's
complete and unredacted contracts upon the pharmacy's request.
Proposed law requires a pharmacy services administrative organization to remit to a contracted
pharmacy any reimbursements, including sales and use taxes, received on behalf of a pharmacy
within a reasonable amount of time after receipt of the reimbursement.
Proposed law prohibits a pharmacy services administrative organization from retaining any portion
of reimbursements, including dispensing fees, direct or indirect remuneration fees, sales and use
taxes, or any other amount owed to a pharmacy. Proposed law provides that when a pharmacy services administrative organization has not yet
received final payment, retroactive adjustments, or reconciliations from a plan sponsor or pharmacy
benefits manager, or funds are being held to pay amounts owed by the pharmacy, proposed law (R.S.
22:1660.5) regarding reimbursement and fees does not apply.
Proposed law authorizes the commissioner of insurance, in accordance with the Louisiana Insurance
Code or the APA, to suspend, revoke, or place on probation the license of a pharmacy services
administrative organization if such organization is determined by the commissioner to have violated
any provision of proposed law.
(Adds R.S. 22:1660.1-1660.6)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the original bill:
1. Specify for the commissioner's registration fee to not exceed $300.00.
2. Delete language that would have subjected pharmacy services administrative
organizations to present law (R.S. 40:2861 et seq.) regulations for pharmacy benefits
managers.
3. Delete language with respect to conflicts of interests, other conduct, and the duty of a
fiduciary relationship owed by a pharmacy services administrative organization to a
pharmacy.
4. Provide that a pharmacy services administrative organization is not responsible for the
activities solely within the purview of a pharmacy benefits manager.
5. Require the commissioner of insurance to promulgate rules to define the roles and
responsibilities solely within the purview of pharmacy benefits managers and pharmacy
services administrative organizations.
6. Define the term "clean claim" and prohibit a plan sponsor or pharmacy benefits manager
from retroactively reducing payments on clean claims unless certain conditions apply;
however, if a written agreement exists, retroactive increases in payment to a pharmacy
are allowable.
7. Require a pharmacy services administrative organization to provide a contracted
pharmacy with access to the pharmacy’s complete and unredacted contracts upon the
pharmacy's request.
8. Provide that when a pharmacy services administrative organization has not yet received
final payment, retroactive adjustments, or reconciliations from a plan sponsor or pharmacy benefits manager, or funds are being held to pay amounts owed by the
pharmacy, proposed law (R.S. 22:1660.5) does not apply.
9. Make technical changes.