Louisiana Revised Statutes 22:1657 – A. A pharmacy benefit manager shall be deemed to be a third-party administrator for purposes of this Part. As such, all provisions of this Part shall apply to pharmacy benefit manage
Terms Used In Louisiana Revised Statutes 22:1657
- Commissioner: means the commissioner of insurance through the Department of Insurance. See Louisiana Revised Statutes 22:1641
- Contract: A legal written agreement that becomes binding when signed.
- Pharmacy benefit manager: means a person, business, or other entity and any wholly or partially owned or controlled subsidiary of such entity that either directly or through an intermediary manages or administers the prescription drug and device portion of one or more health benefit plans on behalf of a third party, including insurers, plan sponsors, insurance companies, unions, and health maintenance organizations, in accordance with a pharmacy benefit management plan. See Louisiana Revised Statutes 22:1641
A. A pharmacy benefit manager shall be deemed to be a third-party administrator for purposes of this Part. As such, all provisions of this Part shall apply to pharmacy benefit managers; however, notwithstanding the provisions of La. Rev. Stat. 22:1651(F), every pharmacy benefit manager shall be required to be licensed by the commissioner of insurance.
B.(1) No pharmacy benefit manager or other entity that administers prescription drug benefits in Louisiana shall prohibit, by contract, a pharmacy or pharmacist from informing a patient of all relevant options when acquiring their prescription medication, including but not limited to the cost and clinical efficacy of a more affordable alternative if one is available and the ability to pay cash if a cash payment for the same drug is less than an insurance copayment or deductible payment amount.
(2) On or after August 1, 2018, any contract provision prohibiting the communication provided for in this Subsection shall be severable from the contract and considered void and not enforceable in Louisiana.
C. The commissioner of insurance shall provide a dedicated location on the department’s website for pharmacy benefit manager information and links.
D. For each of a pharmacy benefit manager’s contractual or other relationships with a health benefit plan or health insurance issuer, the pharmacy benefit manager shall provide the department with the health benefit plan’s formulary and provide timely notification of formulary changes and product exclusions. The information provided pursuant to this Subsection shall be made available in a centralized location on the department’s website in a format that allows for consumer access, including links to pharmacy benefit manager websites.
Acts 2008, No. 386, §1, eff. Jan. 1, 2009; Acts 2011, No. 94, §1, eff. Jan. 1, 2012; Acts 2018, No. 317, §1; Acts 2018, No. 371, §1, eff. Jan. 1, 2020.