SSHB244 3264 3575
HOUSE SUMMARY OF SENATE AMENDMENTS
HB 244 2021 Regular Session Turner
INSURANCE/HEALTH: Provides for the regulation of pharmacy services administrative
organizations
Synopsis of Senate Amendments
1.Removes the definition of "clean claim" and provisions regarding contractual
agreements and the receipt and payment of claims.
2.Removes provisions regarding reimbursement of fees.
3.Makes technical changes.
Digest of Bill as Finally Passed by Senate
Proposed law defines "pharmacy services administrative organization" and "pharmacy
services administrative organization contract".
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 a pharmacy
services administrative organization to file an annual report. Further sets a $300.00 licensing
fee and a $150.00 annual report filing fee.
Proposed law prohibits a person from acting as a pharmacy services administrative
organization in this state without a valid license issued by the commissioner. Requires a
pharmacy services administrative organization's application for licensure to include certain
documents and pertinent information. Authorizes the commissioner, upon his request, to
inspect copies of certain contracts to determine qualification for licensure. Further authorizes
the commissioner to deny or revoke a license for certain cause.
Proposed law provides for a license to remain valid as long as the pharmacy services
administrative organization continues business in this state and remains in compliance with
proposed law. Exempts a pharmacy services administrative organization from La. licensure
requirements when certain out-of-state conditions apply.
Proposed law requires a pharmacy services administrative organization to notify the
commissioner of any material changes in fact or circumstance relative to its license
qualification.
Proposed law requires the commissioner to suspend, revoke, or deny the license of a
pharmacy services administrative organization, or to impose a fine for violations not in
excess of $500.00 per violation when the pharmacy services administrative organization has
failed to timely pay a judgment rendered against it. Further authorizes the commissioner to
suspend, revoke, or deny the license of a pharmacy services administrative organization or
impose a fine for certain other violations.
Proposed law authorizes the commissioner to access the books and records maintained by
a pharmacy services administrative organization for the purposes of examination, audit, and
inspection, and authorizes the commissioner to cause an examination of a pharmacy services
administrative organization, when deemed necessary. Requires the commissioner to keep
any trade secrets contained in books and records confidential; however, the commissioner
may use such information in any proceeding instituted against the pharmacy services
administrative organization.
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Proposed law requires information provided to the commissioner by a pharmacy services
administrative organization and certain terms and contracts between certain parties to remain
confidential. This information is not subject to subpoena and is not public information,
except it may be provided to insurance departments in other states for certain purposes.
Proposed law authorizes the commissioner to adopt rules and regulations necessary to
implement proposed law.
Proposed law obligates the duties of care, competence, good faith, fair dealing, and loyalty
to be performed by a pharmacy services administrative organization that contracts with a
pharmacy as its agent or to perform activities related to prescription drug benefits.
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 that
interferes with the duties imposed in proposed law. Further prohibits a pharmacy services
administrative organization from engaging in any acts, methods, or practices prohibited as
unfair trade practices in the La. Insurance Code (R.S. 22:1961 et seq.).
Proposed law creates an exception to present law, Public Records Law (R.S. 44:4.1(B)).
(Adds R.S. 22:1660.1-1660.9)
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