The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Brandi Cannon.
DIGEST
SB 171 Reengrossed 2023 Regular Session Fred Mills
Present law provides for the licensing of pharmacy benefit managers (PBM) by the commissioner
of insurance. Proposed law retains present law and requires each PBM licensed by the commissioner
to develop a program in consultation with a plan sponsor to provide incentive payments to eligible
independent network pharmacies for meeting benchmarks or complying with strategies aimed at
improving the health of Louisiana residents covered by the pharmacy benefit manager.
Proposed law provides that the quality incentive program should focus on the health concerns most
affecting Louisiana residents, may be designed in consultation with the Louisiana colleges of
pharmacy, and may reflect the unique needs of the state as designated by each of the nine La. Dept.
of Health regions.
Proposed law provides, that on or before October first of each year, a PBM shall report to the
commissioner the details of its program and provides for the minimum content of the report.
Proposed law further provides that the program shall be implemented on the following January first.
Proposed law provides, that on or before April first of the following year, a PBM shall report to the
commissioner the results of its quality incentive criteria from the previous calendar year. Proposed
law further provides for the minimum content of the report.
Proposed law provides that the PBM quality incentive program shall be strictly voluntary and no
independent network pharmacy shall be penalized for declining to participate.
Proposed law provides for additional parameters of the PBM quality incentive program, including
the use of education and training programs.
Present law exempts Medicaid managed care organizations from certain provisions of Title 22.
Proposed law retains present law and provides that Medicaid manage care organization PBMs are
exempt from proposed law. Proposed law requires exempt PBMs to submit a notice of exemption
to the commissioner of insurance and provides that the PBM shall no longer be exempt if they render
services to Louisiana residents who are not enrolled in the Medicaid program.
Proposed law shall not be construed to expand the scope of practice of a participating pharmacist.
Proposed law defines "independent network pharmacy" as a pharmacy operating within the state
which is a member of a pharmacy benefit manager's network, is considered to be in good standing
by the pharmacy benefit manager, and is under common ownership with not more than two other
pharmacies. Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 22:1657.2)
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Clarify that the PBM will develop the quality incentive program with the plan
sponsor.
2. Add an educational and training component option to the quality incentive program.
3. Require financial options to achieve desired outcomes be presented to the plan
sponsor and clarify that the PBM shall continue regular review of existing
relationships with independent network pharmacies.
4. Clarify that Medicaid manage care organization PBMs are exempt from proposed law
unless they provide services to Louisiana residents who are not enrolled in the
Medicaid program.
5. Make technical changes.