The original instrument was prepared by Jerry J. Guillot. The following digest, which
does not constitute a part of the legislative instrument, was prepared by Cathy R.
Wells.
DIGEST
SB 181 Reengrossed 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 increasing 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. Proposed law requires that the 30 day notice of
modification of coverage include information on the issuer's process for an enrollee's physician to
request an exception from the issuer's modification of drug coverage based on a price increase.
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 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))
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Requires the 30 day notice of modification of coverage to include information on the
issuer's process for an enrollee's physician to request an exception from the issuer's
modification of drug coverage based on a price increase.