SLS 24RS-440 ORIGINAL
2024 Regular Session
SENATE BILL NO. 241
BY SENATOR TALBOT
HEALTH/ACC INSURANCE. Provides relative to coverage of certain physician-
administered drugs. (gov sig)
1 AN ACT
2 To amend and reenact R.S. 22:1020.53(A)(1), relative to physician-administered drugs; to
3 provide for insurance reimbursement for physician-administered drugs from certain
4 sources; to provide for an effective date; and to provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1020.53(A)(1) is hereby amended and reenacted to read as
7 follows:
8 ยง1020.53. Physician-administered drugs; access; payment
9 A.(1) A health insurance issuer, pharmacy benefit manager, or their agent
10 shall not refuse to authorize, approve, or pay a participating provider for providing
11 covered physician-administered drugs and related services to covered persons. A
12 health insurance issuer shall not condition, deny, restrict, refuse to authorize or
13 approve, or reduce payment to a participating provider for a physician-administered
14 drug when all criteria for medical necessity are met, because the participating
15 provider obtains physician-administered drugs from a pharmacy that is not a
16 participating provider in the health insurance issuer's network or from a wholesaler,
17 distributor, or other source not selected by the health insurance issuer,
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 241
SLS 24RS-440 ORIGINAL
1 pharmacy benefits manager, or their agent. The drug supplied shall meet the
2 supply chain security controls and chain of distribution set by the federal Drug
3 Supply Chain Security Act, Pub. L. 113-54, as amended. The payment shall be at the
4 rate set forth in the health insurance issuer's agreement with the participating
5 provider applicable to such drugs, or if no such rate is included in the agreement,
6 then at the wholesale acquisition cost. A health insurance issuer, pharmacy benefit
7 manager, or their agent, shall not require a covered person to pay an additional fee,
8 or any other increased cost-sharing amount in addition to applicable cost-sharing
9 amounts payable by the covered person as designated within the benefit plan to
10 obtain the physician-administered drug when provided by a participating provider.
11 However, nothing in this Subpart shall prohibit a health insurance issuer or its agent
12 from establishing differing copayments or other cost-sharing amounts within the
13 benefit plan for covered persons who acquire physician-administered drugs from
14 other providers. Nothing in this Subpart shall prohibit a health insurance issuer or its
15 agent from refusing to authorize or approve, or from denying coverage of a
16 physician-administered drug based upon failure to satisfy medical necessity criteria.
17 For purposes of this Section, the location of receiving the physician-administered
18 drug shall not be included in the medical necessity criteria.
19 * * *
20 Section 2. This Act shall become effective upon signature by the governor or, if not
21 signed by the governor, upon expiration of the time for bills to become law without signature
22 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
23 vetoed by the governor and subsequently approved by the legislature, this Act shall become
24 effective on the day following such approval.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Brandi Cannon.
DIGEST
SB 241 Original 2024 Regular Session Talbot
Present law prohibits a health insurance issuer, pharmacy benefit manager, or their agent
from refusing to authorize, approve, or pay a participating provider for providing covered
physician-administered drugs and related services to covered persons.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 241
SLS 24RS-440 ORIGINAL
Proposed law retains present law.
Present law prohibits a health insurance issuer, pharmacy benefit manager, or their agent
from conditioning, denying, restricting, refusing to authorize or approve, or reducing
payment to a participating provider for a physician-administered drug when all criteria for
medical necessity are met because the participating provider obtains physician-administered
drugs from a pharmacy that is not a participating provider in the health insurance issuer's
network.
Proposed law retains present law and extends the payment protection to apply to a physician-
administered drug that is obtained from a wholesaler, distributor, or other source not selected
by the health insurance issuer, pharmacy benefits manager, or their agent.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1020.53(A)(1))
Page 3 of 3
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.