Terms Used In Louisiana Revised Statutes 22:1867

  • Pharmacy: means any appropriately licensed place where prescription drugs are dispensed as defined in La. See Louisiana Revised Statutes 22:1863
  • Pharmacy benefit manager: means an entity that administers or manages a pharmacy benefits plan or program. See Louisiana Revised Statutes 22:1863
  • Spread pricing: means any amount a pharmacy benefit manager charges or claims from a health plan provider or managed care organization for payment of a prescription or for pharmacy services that is different than the amount the pharmacy benefit manager paid to the pharmacist or pharmacy who filled the prescription or provided the pharmacy services. See Louisiana Revised Statutes 22:1863

            A. A pharmacy benefit manager is prohibited from conducting or participating in spread pricing in this state unless the pharmacy benefit manager provides written notice as provided in Subsection B of this Section.

            B. The notice issued by a pharmacy benefit manager, or a health insurance issuer where the health insurance issuer has agreed to issue the notice, that utilizes spread pricing shall be:

            (1) Required for each health insurance issuer or plan provider in which the pharmacy benefit manager engaged or participated in spread pricing.

            (2) Delivered to the policy holder.

            (3) Provided at least biannually.

            (4) Indicative of the aggregate amount of spread pricing charged by the pharmacy benefit manager during the period.

            (5) Written in plain, simple, and understandable English.

            C. Any violation of this Section that is committed or performed with such frequency as to indicate a general business practice shall be subject to the provisions of the Unfair Trade Practices and Consumer Protection Law, La. Rev. Stat. 51:1401 et seq., as provided in La. Rev. Stat. 40:2870(B).

            Acts 2019, No. 124, §1, eff. July 1, 2020.

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