RÉSUMÉ DIGEST
ACT 102 (SB 180) 2021 Regular Session Fred Mills
Prior law provided for the use of a reverse auction by a political subdivision to purchase
materials, supplies, or equipment when the procurement officer determines that the best
interests of the political subdivision would be served and that electronic online bidding is
more advantageous than other procurement methods. New law provides that consulting
services may also be procured through the reverse auction process.
Prior law provided for the use of a reverse auction by the state for the acquisition of
materials, supplies, services of any type, products, or equipment with the approval of the
state chief procurement officer that the best interests of the state would be served. New law
provides that consulting services may also be procured through the reverse auction process.
Prior law defined consulting service for the purposes of the Louisiana Procurement Code and
provides examples of consulting services. New law adds pharmacy benefit manager (PBM)
services as an example.
New law provides that the division of administration may procure PBM services for the
administration of benefits provided by the Office of Group Benefits through the reverse
auction process and establishes the standards and procedures. New law provides for
legislative intent and defines key terms.
New law provides for the mandatory content of contracts for PBM services obtained through
reverse auction including the minimum capabilities of the technology platform, the required
related services from the technology platform provider, and the time limit for procuring the
technology platform and related technology provider.
New law provides that if the division of administration uses a reverse auction to procure
PBM services as authorized by new law, the division shall not award a contract for the
technology platform and related provider services to a PBM and prohibits the vendor from
outsourcing any part of the reverse auction or review of invoiced drug claims.
New law provides that the technology platform used to conduct the reverse auction shall be
repurposed over the duration of the PBM services contract as an automated pharmacy claims
adjudication engine to perform real-time, electronic, line-by-line, claim-by-claim review of
100% of invoiced PBM prescription drug claims, and identify all deviations from the specific
terms of the PBM services contract. New law requires the division of administration to
reconcile the electronically adjudicated pharmacy claims with PBM invoices on a monthly
or quarterly basis to ensure that state payments shall not exceed the terms specified in any
PBM services contract.
New law provides for the timeline for the completion of each PBM reverse auction and
requires notice of the dates of the scheduled PBM reverse auction and the termination of the
existing PBM services contract to be given to the Joint Legislative Committee on the Budget.
New law provides that the division of administration shall implement a no-pay option that
obligates the winning PBM, rather than the state, to pay the cost of the technology platform
and related technology platform provider services by assessing the PBM a per-prescription
fee in an amount agreed to by the division of administration and the technology provider and
requiring the PBM to pay these fees to the technology provider over the duration of the PBM
services contract.
New law does not apply in the case of a nonprofit, nongovernmental health maintenance
organization with respect to managed care plans that provide a majority of covered
professional services through a single contracted medical group.
New law provides that any other self-funded public sector health plan may use the processes
and procedures established in new law individually, collectively, or as a joint purchasing
group with the group benefit plans provided by the Office of Group Benefits. Proposed law
further authorizes, after completion of the first PBM reverse auction, self-funded private
sector health plans with substantial participation by La. employees and their dependents to participate in a joint purchasing pool with state employees for subsequent PBM reverse
auctions.
Prior law provided that the Louisiana Department of Health (LDH) shall administer the
Medicaid prescription drug benefit program and requires contracts for PBM services, either
directly with LDH or as a subcontractor or subsidiary of a managed care organization, to
meet certain requirements. New law adds authority for LDH to procure and negotiate PBM
contracts through the use of a reverse auction.
Prior law provided that the Office of Group Benefits may negotiate and contract directly for
the provision of other health care services to the program's covered persons. New law adds
authority for OGB to procure and negotiate PBM contracts through the use of a reverse
auction.
New law provides that the Jt. Legislative Committee on the Budget shall review and approve
any proposed contract to implement a PBM reverse auction.
Effective August 1, 2021.
(Amends R.S. 38:2271(A)(1) and (2)(b) and 2271(C)(intro para) and R.S. 39:1556(10)(a) and
(50), 1600(D)(1) and (3), 1621(B), and 1648(C); adds R.S. 39:1600.1, R.S. 42:802(B)(12),
and R.S. 46:450.7(C))