SLS 21RS-424 ORIGINAL
2021 Regular Session
SENATE BILL NO. 181
BY SENATOR BOUDREAUX
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURERS. Provides relative to health insurance coverage modifications and unfair or
deceptive practices. (8/1/21)
1 AN ACT
2 To amend and reenact R.S. 22:1068(D)(3), 1074(D)(3), and 1964(15)(a)(ii), relative to
3 health insurance; to provide for the guaranteed renewability of health insurance
4 coverage; to authorize the modification of drug coverage under certain
5 circumstances; to provide for unfair methods, acts, or practices by health insurers
6 against certain pharmacies and pharmacists; and to provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1068(D)(3), 1074(D)(3), and 1964(15)(a)(ii) are hereby
9 amended and reenacted to read as follows:
10 §1068. Guaranteed renewability of coverage for employers in the group market
11 * * *
12 D. A health insurance issuer may modify health insurance coverage offered
13 to a group health plan if each of the following conditions is met:
14 * * *
15 (3) The issuer notifies, on a form approved by the Department of Insurance,
16 each affected covered small or large employer and enrollee of the modification,
17 including modification of coverage of a particular product or modification of drug
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Coding: Words which are struck through are deletions from existing law;
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1 coverage, not later than the sixtieth day before the date the modification is effective.
2 Notwithstanding the requirements of Paragraph (D)(1) of this Section,
3 modification of drug coverage for any drug costing over three hundred dollars
4 per prescription or refill with an increase in the wholesale acquisition cost of at
5 least twenty-five percent in the prior three hundred sixty-five days may occur
6 at any time provided that thirty-day notice of the modification of coverage is
7 given.
8 * * *
9 §1074. Guaranteed renewability of individual health insurance coverage
10 * * *
11 D. A health insurance issuer may modify the health insurance coverage for
12 a policy form offered to individuals in the individual market if each of the following
13 conditions is met:
14 * * *
15 (3) The issuer notifies, on a form approved by the Department of Insurance,
16 each affected individual of the modification, including modification of coverage of
17 a particular product or modification of drug coverage, not later than the sixtieth day
18 before the date the modification is effective. Notwithstanding the requirements of
19 Paragraph (D)(1) of this Section, modification of drug coverage for any drug
20 costing over three hundred dollars per prescription or refill with an increase in
21 the wholesale acquisition cost of at least twenty-five percent in the prior three
22 hundred sixty-five days may occur at any time provided that thirty-day notice
23 of the modification of coverage is given.
24 * * *
25 §1964. Methods, acts, and practices which are defined as unfair or deceptive
26 The following are declared to be unfair methods of competition and unfair
27 or deceptive acts or practices in the business of insurance:
28 * * *
29 (15)(a) The issuance, delivery, issuance for delivery, or renewal of, or
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1 execution of a contract for, a health benefits policy or plan which:
2 * * *
3 (ii) Denies a pharmacy licensed and physically located in the state or a
4 pharmacist licensed in the state the right to participate as a contract provider of
5 pharmaceutical services or pharmaceutical products under the policy or plan, or
6 under a pharmacy network established by the policy or plan, if the pharmacy or
7 pharmacist agrees in writing to provide pharmaceutical services and pharmaceutical
8 products that meet all the terms and requirements, including the same administrative,
9 financial, and professional conditions and a minimum contract term of one year, if
10 requested, which apply to pharmacies and pharmacists which have been designated
11 as providers under the policy or plan or as participating providers in a pharmacy
12 network established by the policy or plan.
13 * * *
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Jerry J. Guillot.
DIGEST
SB 181 Original 2021 Regular Session Boudreaux
Present law provides for guaranteed renewability of health coverage for employees in the
group market and persons with individual health coverage.
Present law authorizes a health insurance issuer to modify the health insurance coverage for
a policy form offered to a group health plan or to individuals in the individual market if each
of the following conditions is met:
(1)The modification occurs at the time of coverage renewal.
(2)The modification is approved by the commissioner of insurance and is on a uniform
basis among all individuals and all small and large employers covered by the group
health plan.
(3)The insurer notifies each individual or group no later than the 60th day before the
modification is effective.
Proposed law retains present law but as to the notification requirement, modification of drug
coverage is allowed at any time as to a drug costing over $300 per prescription or refill with
an increase in the wholesale acquisition cost of at least 25% in the prior 365 days provided
that 30-day notice of the modification of coverage is given.
Present law provides for certain unfair methods of competition and unfair or deceptive acts
or practices in the business of insurance.
Present law provides that the issuance, delivery, issuance for delivery, or renewal of, or
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Coding: Words which are struck through are deletions from existing law;
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execution of a contract for, a health benefits policy or plan which denies a pharmacy or
pharmacist the right to participate as a contract provider of pharmaceutical services or
pharmaceutical products under the policy or plan, or under a pharmacy network established
by the policy or plan, if the pharmacy or pharmacist agrees in writing to provide
pharmaceutical services and pharmaceutical products that meet all the terms and
requirements, including the same administrative, financial, and professional conditions and
a minimum contract term of one year, if requested, which apply to pharmacies and
pharmacists which have been designated as providers under the policy or plan or as
participating providers in a pharmacy network established by the policy or plan.
Proposed law retains present law but limits the prohibition to pharmacies licensed and
physically located in the state as well as pharmacists licensed in this state.
Effective August 1, 2021.
(Amends R.S. 22:1068(D)(3), 1074(D)(3), and 1964(15)(a)(ii))
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.