Provides relative to the payment of pharmacy claims. (See Act) (RE INCREASE SG EX See Note)
The proposed law enforces stricter standards regarding how and when audits are conducted by PBMs. As of January 2022, individuals conducting audits must pass an examination to ensure they are knowledgeable about pharmacy records and insurance laws. Moreover, the bill prohibits PBMs from charging local pharmacies fees related to claims without clear justification. By limiting payment reductions and outlawing spread pricing practices by 2025, the legislation aims to create a more equitable reimbursement structure for pharmacies, thus fostering a healthier local pharmacy market and improving access to medications for the state’s residents.
Senate Bill 218, sponsored by Senator Fred Mills, addresses the regulation and payment standards for pharmacy claims in Louisiana. The bill revises existing statutes concerning pharmacy benefit managers (PBMs) and sets clearer guidelines for the auditing process of pharmacy records. Notably, it places limitations on the frequency of audits, as well as the number of prescriptions each pharmacy can be audited for within a single year. The intent of these amendments is to provide greater protection and financial clarity for local pharmacies, which are often at a disadvantage compared to larger chains in negotiating terms with PBMs.
The sentiment surrounding SB 218 appears to be largely supportive among pharmacy groups and local business advocates, who believe the bill will help level the playing field. Proponents argue that these regulations will protect smaller pharmacies from unfair practices by larger entities, ultimately benefiting patients through better access to affordable medications. However, some concerns have been raised regarding the potential responses from PBMs and health insurers who may be affected by the stricter regulations, suggesting a need for careful navigation of policy implementation to avoid unintended consequences in the healthcare system overall.
Although many stakeholders support SB 218, there are apprehensions about how the bill's provisions, especially those about audits and reimbursements, will be enforced. Critics point out that while the law aims to prevent unfair practices by PBMs, it could also lead to a reduction in the willingness of these entities to work with local pharmacies. Furthermore, opposing arguments highlight that the bill may limit the operational flexibility of PBMs, which could ultimately impact the pricing and availability of drugs for consumers, indicating a fundamental conflict between protecting local pharmacies and maintaining a competitive pharmaceutical market.