Provides for reimbursement rates paid by Pharmacy Benefit Managers. (8/1/25) (OR NO IMPACT SG EX See Note)
Impact
The bill modifies current laws regarding the reimbursement rates from PBMs, mandating that if a pharmacy appeals a reimbursement decision and is successful, the PBM must notify all similarly situated pharmacies about the changes and allow them to resubmit claims at the adjusted rate. This new requirement ensures that pharmacies can receive fair reimbursement not only for themselves but also for other pharmacies that may be impacted by similar pricing issues. Additionally, it obligates PBMs to make retroactive price adjustments in upcoming payment cycles, which can significantly affect financial aspects for many pharmacies.
Summary
Senate Bill 173, introduced by Senator Jackson-Andrews, focuses on the reimbursement practices of pharmacy benefit managers (PBMs) for pharmacies and pharmacists in Louisiana. The bill aims to ensure that pharmacies are reimbursed at least at the acquisition cost for the drugs, devices, or services they provide. Furthermore, it seeks to establish a clear appeals process for pharmacies that challenge reimbursement rates set by PBMs, thereby enhancing transparency and fairness in pharmacy operations. The proposed legislation is set to take effect on August 1, 2025.
Sentiment
The sentiment surrounding SB 173 appears to lean towards support from pharmacy advocates who argue that the legislation protects small pharmacies from potentially exploitative practices of larger PBMs. Supporters believe that the bill will positively impact local pharmacies and ensure they can operate sustainably without undercutting their costs. Conversely, some skepticism exists regarding the administrative burden this may place on PBMs and whether it will lead to increased drug prices for consumers in the long run.
Contention
Despite the potential benefits of SB 173, there may be points of contention, especially concerning how effectively the appeals process will function in practice. Critics might argue about the complexities involved in the implementation and whether PBMs will comply with the new requirement to notify pharmacies. The discussion could also focus on concerns from PBMs about how this bill might affect their operational processes and cost structures, leading to heightened tension between pharmacy advocates and PBM representatives.
Requests the legislative auditor to evaluate the oversight and management of the Office of Group Benefits' contracts with pharmacy benefit managers to provide pharmacy benefits for state employees and retirees (EN NO IMPACT See Note)
Provides relative to state procurement of pharmacy benefit manager services by use of reverse auction technology. (8/1/23) (RE SEE FISC NOTE EX See Note)
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.