Louisiana Revised Statutes 22:1860.2 – A. A health insurance issuer or a pharmacy benefit manager shall not directly or indirectly charge or hold a pharmacist or pharmacy responsible for any fee related to a claim that is
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Terms Used In Louisiana Revised Statutes 22:1860.2
- Claim: means a request by a pharmacist for payment by a health insurance issuer. See Louisiana Revised Statutes 22:1852
- Health insurance issuer: means an insurance company, including a health maintenance organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Title, unless preempted as an employee benefit plan under the Employee Retirement Income Security Act of 1974. See Louisiana Revised Statutes 22:1852
- Pharmacist: means an individual currently licensed as a pharmacist by the Louisiana Board of Pharmacy to engage in the practice of pharmacy in this state. See Louisiana Revised Statutes 22:1852
- Remittance advice: means a written or electronic communication explaining the health insurance issuer's action on each claim adjudicated by the issuer. See Louisiana Revised Statutes 22:1852
A. A health insurance issuer or a pharmacy benefit manager shall not directly or indirectly charge or hold a pharmacist or pharmacy responsible for any fee related to a claim that is any of the following:
(1) Not apparent at the time of claim processing.
(2) Not reported on the remittance advice of an adjudicated claim.
(3) After the initial claim is adjudicated.
B. For purposes of this Section, “pharmacy benefit manager” means a person, other than a pharmacy or pharmacist, who acts as an administrator in connection with pharmacy benefits.
Acts 2016, No. 148, §1; Acts 2019, No. 105, §1, eff. June 4, 2019.