The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Senate Legislative Services. The keyword,
summary, and digest do not constitute part of the law or proof or indicia of legislative
intent. [R.S. 1:13(B) and 24:177(E)]
DIGEST
SB 173 Original 2025 Regular Session Jackson-Andrews
Present law requires a pharmacy benefit manager reimburse a pharmacy or pharmacist in an amount
at least equal to the pharmacies' or pharmacists' acquisition cost for a covered drug, device, or
service.
Proposed law retains present law and defines "acquisition cost".
Present law provides an administrative appeal procedure for pharmacies challenging the maximum
allowable cost for a drug set by a pharmacy benefit manager as not in compliance with state law.
Proposed law retains present law.
Proposed law requires that when an appeal is granted, the pharmacy benefit manager is required to
take the following actions:
(1)Permit the appealing pharmacy and all similarly situated pharmacies that dispensed the drug
to reverse and resubmit claims and receive payment based on the adjusted cost of the drug.
(2)Make the change effective for all similarly situated pharmacies and individually notify each
pharmacy that a retroactive reimbursement adjustment has been made due to the granting of
the appeal, and that the pharmacy resubmit and receive payment based on the adjusted rate.
(3)Make retroactive price adjustments in the next payment cycle.
Effective August 1, 2025.
(Amends R.S. 22:1860.3(E) and 1865(E))