SB 381

SLS 26RS-246  ORIGINAL
 2026 Regular Session
 SENATE BILL NO. 381
 BY SENATOR BASS
 HEALTH/ACC INSURANCE. Provides for pharmacy benefit managers. (gov sig)
1AN ACT
2 To amend and reenact R.S. 22:1865(A) and 1868.1(A) and to enact R.S. 22:1868.2, relative
3to pharmacy benefit managers; to prohibit PBMs from obtaining rebates on brand
4name drugs in exchange for not placing generic drugs on the PBM's formulary; to
5provide for PBM formularies; and to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7Section 1. R.S. 22:1865(A) and 1868.1(A) are hereby amended and reenacted and
8 R.S. 22:1868.2 is hereby enacted to read as follows:
9§1865. Appeals; maximum allowable costs
10A.(1) The pharmacy benefit manager shall provide a reasonable
11administrative appeal procedure to allow pharmacies to challenge maximum
12allowable costs for a specific NDC or NDCs as not meeting the requirements of this
13Subpart or being below the cost at which the pharmacy may obtain the NDC. Within
14fifteen business days after the applicable fill date, a pharmacy may file an appeal by
15following the appeal process as provided for in this Subpart. The pharmacy benefit
16manager shall respond to a challenge within fifteen business days after receipt of the
17challenge.
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1(2) The administrative appeal procedure shall allow a pharmacy or
2      pharmacist the option to submit a consolidated appeal representing multiple
3      substantially similar claims.
4*      *       *
5      §1868.1. Pharmacy benefit manager rebate retention restrictions; fee disclosure
6A.(1) A pharmacy benefit manager may negotiate, but shall not retain any
7      portion of rebates received from a drug manufacturer. All manufacturer rebates shall
8      be passed through to the plan sponsor as shared savings in the form of lower
9      premiums, reduced cost-sharing including reduced copays, coinsurance, or
10      deductibles for prescription drugs, or to provide broader drug coverage. The specific
11      allocation of rebates and how they are shared with plan members shall be identified
12      in the plan sponsor's plan design and contract terms.
13(2) A pharmacy benefit manager shall not obtain a rebate, or any other
14      incentive or inducement including but not limited to discounts, on a name brand
15      drug in exchange for not placing other name brand drugs, biosimilars, generic
16      drugs, or any other drug in the same class of drugs on the PBM formulary.
17*      *       *
18      §1868.2. Pharmacy benefit manager formularies
19A. As used in this Section, the following terms have the following
20      meanings:
21(1) "Affiliated manufacturer" means a drug or biological product
22      manufacturer that, either directly or indirectly through one or more
23      intermediaries, meets one or more of the following criteria:
24(a) Has an investment or ownership interest in a pharmacy benefit
25      manager.
26(b) Shares common ownership with a pharmacy benefit manager.
27(c) Has an investor or a holder of an ownership interest in a pharmacy
28      benefit manager.
29(2) "Biological product" has the same meaning as in the Public Health
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  SB NO. 381
1      Service Act, 42 U.S.C. 262.
2(3) "Biosimilar" has the same meaning as in the Public Health Service
3      Act, 42 U.S.C. 262.
4(4) "Interchangeable" has the same meaning as in the Public Health
5      Service Act, 42 U.S.C. 262.
6B.(1) A pharmacy benefit manager revising the formulary of covered
7      prescription drugs at the beginning of a plan year shall provide a sixty day
8      continuity-of-care period in which the covered prescription drug that is being
9      revised from the formulary continues to be provided at the same cost for the
10      insured for a period of sixty days.
11(2) The sixty day continuity-of-care period commences upon notification
12      to the insured by the insurer.
13(3) This Subsection does not apply if any of the following have occurred
14      regarding the covered prescription drug:
15(a) The prescription drug has been made available over the counter by
16      the United States Food and Drug Administration and has entered the
17      commercial market as such.
18(b) The prescription drug has been removed or withdrawn from the
19      commercial market by the manufacturer.
20(c) The prescription drug is subject to an involuntary recall by state or
21      federal authorities and is no longer available on the commercial market.
22B. A pharmacy benefit manager shall not require an insured to receive
23      a drug or biological product that is manufactured by an affiliated manufacturer
24      when there is an available generically equivalent drug, or an available biological
25      product that is biosimilar to and interchangeable for the prescribed biological
26      product.
27C. A pharmacy benefit manager shall not require an insured to receive
28      a more expensive name brand drug when less expensive name brand drugs,
29      biosimilars, generic drugs, or any other drug in the same class of drugs are
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1available.
2D. Other than at the time of coverage renewal, a pharmacy benefit
3manager shall not, while an insured is taking a prescription drug, do any of the
4following:
5(1) Remove the prescription drug from its list of covered drugs during
6the policy year unless any of the following have occurred:
7(a) The United States Food and Drug Administration has issued a
8statement about the drug which calls into question the clinical safety of the
9drug.
10(b) The manufacturer of the drug has notified the United States Food
11and Drug Administration of a manufacturing discontinuance or potential
12discontinuance of the drug as required by the federal Food, Drug, and Cosmetic
13Act, 21 U.S.C. 356.
14(c) The drug has been approved and made available over the counter by
15the United States Food and Drug Administration and entered the commercial
16market as such.
17(2) Reclassify the drug to a more restrictive drug tier or increase the
18amount that an insured must pay for a copayment, coinsurance, or deductible
19for prescription drug benefits, or reclassify the drug to a higher cost-sharing
20tier during the policy year.
21E. This Section does not prohibit the addition of prescription drugs to the
22formulary during the policy year.
23Section 2. This Act shall become effective upon signature by the governor or, if not
24 signed by the governor, upon expiration of the time for bills to become law without signature
25 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
26 vetoed by the governor and subsequently approved by the legislature, this Act shall become
27 effective on the day following such approval.
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SLS 26RS-246  ORIGINAL
  SB NO. 381
   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 381 Original  2026 Regular Session  Bass
Present law provides pharmacists and pharmacies an administrative appeal with a PBM over
reimbursement costs. Proposed law retains present law and further allows a pharmacist or
pharmacy to submit a consolidated appeal representing multiple substantially similar claims.
Present law prohibits PBMs from retaining rebates negotiated with a drug manufacturer.
Proposed law retains present law.
Proposed law prohibits a PBM from obtaining rebates on name brand drugs in exchange for
not placing drugs in the same class of drugs on the PBM's drug formulary.
Proposed law provides for definitions.
Proposed law requires a PBM revising the formulary of covered drugs to provide a 60 day
continuity-of-care period when a drug being removed from the formulary continues to be
provided at the same cost. Further provides for exceptions to the continuity-of-care
requirement.
Proposed law prohibits a PBM from requiring an insured receive a drug that is manufactured
by an affiliated manufacturer of the PBM when a generically equivalent drug is available.
Proposed law prohibits a PBM from requiring the use of more expensive name brand drugs
when less expensive drugs in the same class are available.
Proposed law prohibits the removal of a drug from the formulary during a policy year.
Further provides for exceptions.
Proposed law prohibits reclassifying a drug to a more restrictive tier or a higher cost-sharing
tier during a policy year.
Proposed law allows the addition of prescription drugs to the formulary during the policy
year.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1865(A) and 1868.1(A); adds R.S. 22:1868.2)
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   Coding: Words which are struck through are deletions from existing law;
   words in boldface type and underscored are additions.