SB 387

2026 Regular Session  ENROLLED
  ACT No. 914
 SENATE BILL NO. 387
 BY SENATORS BASS AND TALBOT AND REPRESENTATIVE TURNER
1AN ACT
2 To amend and reenact R.S. 22:1856.1(B)(2)(a), 1863, 1865(A), and the introductory
3paragraph of 1865(G), R.S. 39:1600.1(A), the introductory paragraph of 1600.1(D),
4and 1600.1(D)(6), and R.S. 44:4.1(B)(11), to enact R.S. 22:1867.1 and 1868.2, and
5to repeal R.S. 22:1868.1 and Section 5 of Act 474 of the 2025 Regular Session,
6relative to pharmacy benefit managers; to provide for definitions; to provide for the
7costs of implementation and enforcement; to provide for appeals; to provide for a
8duty to enrollees, health plans, and providers; to provide for compensation; to
9provide for rebates, formularies, and cost-sharing; to provide for a private cause of
10action; to provide for audits; to provide for contract and other requirements; to
11provide for data sharing; to provide for penalties; to provide for a public records
12exemption; to provide for an effective date; and to provide for related matters.
13 Be it enacted by the Legislature of Louisiana:
14Section 1. R.S. 22:1856.1(B)(2)(a), 1863, 1865(A), and the introductory paragraph
15 of 1865(G) are hereby amended and reenacted and R.S. 22:1867.1 and 1868.2 are hereby
16 enacted to read as follows:
17§1856.1. Pharmacy record audits; recoupment; appeals
18*       *       *
19B. Notwithstanding any other provision of law to the contrary, when an audit
20of the records of a pharmacy is conducted by an entity, the audit shall be conducted
21in accordance with the following criteria:
22*       *       *
23(2)(a) No entity shall conduct an audit at a particular pharmacy more than one
24time annually. The audit shall be limited to claims submitted not more than
25twelve months prior to date the audit begins. However, the provisions of this
26Paragraph shall not apply when an entity must return to a pharmacy to complete an
27audit already in progress, or there is an identified history of errors, an identified
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1activity which a reasonable man person would believe to be inappropriate, or illegal
2activity that the entity has brought to the attention of the pharmacy owner or
3corporate headquarters of the pharmacy.
4*       *       *
5§1863. Definitions
6As used in this Subpart, the following definitions apply:
7(1) "Drug Shortage List" means a list of drug products posted on the United
8States Food and Drug Administration drug shortage website.
9(2) "Effective rate pricing" means any payment reduction for pharmacist or
10pharmacy services by a pharmacy benefit manager under a reconciliation process for
11direct or indirect remuneration fees, a brand or generic effective rate of
12reimbursement, or any other reduction or aggregate reduction of payment.
13(3) "Enrollee" means any individual entitled to coverage of healthcare
14services under the terms of a health benefit plan.
15(3)(4) "Health benefit plan", "health plan", "plan", "benefit", or "health
16insurance coverage" means services consisting of medical care provided directly
17through insurance, reimbursement, or other means, and including items and services
18paid for as medical care under any hospital or medical service policy or certificate,
19hospital or medical service plan contract, preferred provider organization contract,
20or health maintenance organization contract offered by a health insurance issuer.
21However, excepted benefits are not included as a "health benefit plan".
22(5) "Healthcare service" means an item or service furnished to any
23individual for the purpose of preventing, diagnosing, alleviating, curing, or
24healing human illness, injury, or physical disability.
25(4)(6) "Health insurance issuer" means any entity that offers health insurance
26coverage through a plan, policy, or certificate of insurance subject to state law that
27regulates the business of insurance. "Health insurance issuer" shall also include a
28health maintenance organization, as defined and licensed pursuant to Subpart I of
29Part I of Chapter 2 of this Code.
30(5)(7) "Local pharmacy" means a pharmacy as defined in the North American
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1Industry Classsification Classification System (NAICS) Code 456110, which is
2domiciled in Louisiana and has fewer than ten retail outlets under its corporate
3umbrella, or which is owned and operated by a nonprofit health system, or any
4affiliated hospital, domiciled in Louisiana.
5(6)(8) "Maximum Allowable Cost List" means a listing of the National Drug
6Code used by a pharmacy benefit manager setting the maximum allowable cost on
7which reimbursement to a pharmacy or pharmacist may be based. "Maximum
8Allowable Cost List" shall include any term that a pharmacy benefit manager or a
9healthcare insurer may use to establish reimbursement rates for generic and
10multi-source brand drugs to a pharmacist or pharmacy for pharmacist services.
11(7)(9) "NDC" means the National Drug Code, a numerical identifier assigned
12to all prescription drugs.
13(10) "Person" includes a natural person, corporation, mutual company,
14unincorporated association, partnership, joint venture, limited liability
15company, trust, estate, foundation, not-for-profit corporation, unincorporated
16organization, government or governmental subdivision, or agency.
17(8)(11) "Pharmacist" means a licensed pharmacist as defined in R.S. 22:1852.
18(9)(12) "Pharmacist services" means products, goods, or services provided
19as a part of the practice of pharmacy as defined in R.S. 22:1852.
20(10)(13) "Pharmacy" means any appropriately licensed place where
21prescription drugs are dispensed as defined in R.S. 22:1852.
22(14) "Pharmacy benefit management fee" means a fee that covers the
23cost of providing one or more pharmacy benefit management services and that
24does not exceed the value of the service or services actually performed by the
25pharmacy benefit manager.
26(15) "Pharmacy benefit management service" means any of the
27following:
28(a) Negotiating the price of prescription drugs, including negotiating and
29contracting for direct or indirect rebates, discounts, or other price concessions.
30(b) Managing any aspect of a prescription drug benefit including but not
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1limited to the processing and payment of claims for prescription drugs, the
2performance of drug utilization review, the processing of drug prior
3authorization requests, the adjudication of appeals or grievances related to the
4prescription drug benefit, contracting with network pharmacies, controlling the
5cost of covered prescription drugs, managing or providing data relating to the
6prescription drug benefit, or the provision of services related thereto.
7(c) Performance of any administrative, managerial, clinical, pricing,
8financial, reimbursement, data administration or reporting, or billing service.
9(d) Such other services as the commissioner may define by rule or
10regulation.
11(11)(16) "Pharmacy benefit manager" or "PBM" has the same meaning as
12the term defined in R.S. 22:1641 and includes any person, either directly or
13indirectly, that provides one or more pharmacy benefit management services on
14behalf of an insurer or health plan, and any agent, contractor, intermediary, affiliate,
15subsidiary, or related entity of such person who facilitates, provides, directs, or
16oversees the provision of the pharmacy benefit management services or entity, and
17any subsidiary, parent, or affiliate of such entity that directly or indirectly
18facilitates, provides, directs, manages, administers, or oversees the provision of
19one or more pharmacy benefit management services. The administration or
20management of a prescription benefits plan includes direct or indirect
21participation at any stage in the negotiation or determination of prescription
22drug pricing ultimately assessed to an insurer's or pharmacy benefit manager's
23client health benefit plan.
24(12)(17) "Pharmacy benefits plan" or "pharmacy benefits program" means
25a plan or program that pays for, reimburses, covers the cost of, or otherwise provides
26for pharmacist services to individuals who reside in or are employed in Louisiana.
27(18) "Provider" means an individual or entity that furnishes, provides,
28dispenses, or administers one or more units of a prescription drug.
29(13)(19) "Rebates" means either of the following: all rebates, discounts, and
30other price concessions, based on utilization of a prescription drug and paid by the
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1manufacturer or other party other than an enrollee, directly or indirectly, to the
2pharmacy benefit manager after the claim has been adjudicated at the pharmacy.
3Rebates shall include a reasonable estimate, as determined by the commissioner, of
4any volume-based discount or other discounts.
5(a) Drug manufacturer price concessions including but not limited to
6base price concessions, whether described as a rebate or otherwise, and any
7price protection rebates and performance-based price concessions that may
8accrue directly or indirectly to the pharmacy benefit manager, health insurance
9issuer or health plan, or other party on behalf of the health insurance issuer or
10health plan, including a pharmacy benefit manager, from a manufacturer,
11dispensing pharmacy, or other party in connection with the dispensing or
12administration of a prescription drug.
13(b) Reasonable estimates of any price concessions, fees, and other
14administrative costs that are passed through, or are reasonably anticipated to
15be passed through, to the health insurance issuer or health plan and serve to
16reduce the health insurance issuer or health plan's liabilities for a prescription
17drug.
18(20) "Related entity" means either of the following:
19(a) Any entity, whether foreign or domestic, that is a member of any
20controlled group of corporations, as defined in Section 1563(a) of the Internal
21Revenue Code, except that "fifty percent" shall be substituted for "eighty
22percent" wherever the latter percentage appears in the code, of which a
23pharmacy benefit manager is a member.
24(b) Any of the following persons or entities that are treated as a related
25entity to the extent provided in rules adopted by the commissioner:
26(i) A person other than a corporation that is treated under the rules as
27a related entity of a pharmacy benefit manager.
28(ii) A person or entity that is treated under the rules as affiliated with a
29pharmacy benefit manager in cases where the pharmacy benefit manager is a
30person other than a corporation.
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1(14)(21) "Specialty drug" means a drug that meets all of the following
2criteria:
3(a) The drug is used to treat and is prescribed for a person with a complex,
4chronic, or rare medical condition that is progressive, can be debilitating or fatal if
5left untreated or undertreated, or for which there is no known cure.
6(b) The drug is not routinely stocked at a majority of pharmacies within this
7state.
8(c) The drug has special handling, storage, inventory, or distribution
9requirements.
10(d) Patients receiving the drug require complex education and treatment
11maintenance, such as complex dosing, intensive monitoring, or clinical oversight.
12(15)(22) "Spread pricing" means any amount charged or claimed by a
13pharmacy benefit manager for a prescription drug that exceeds the amount paid by
14the pharmacy benefit manager to the pharmacist or pharmacy for the dispensing of
15the prescription drug, minus a pharmacy benefit management fee.
16(23) "Net acquisition cost" means the amount paid to acquire a
17prescription drug after deducting all rebates, price concessions, fee payments,
18and any other payments or economic benefits received directly or indirectly by
19the pharmacy benefit manager or any related entity in connection with the
20selection, placement, or dispensing of that drug, calculated from the perspective
21of the health benefit plan and not the pharmacy benefit manager.
22*       *      *
23§1865. Appeals; maximum allowable costs
24A.(1) The pharmacy benefit manager shall provide a reasonable
25administrative appeal procedure to allow pharmacies to challenge maximum
26allowable costs for a specific NDC or NDCs as not meeting the requirements of this
27Subpart or being below the cost at which the pharmacy may obtain the NDC. Within
28fifteen business days after the applicable fill date, a pharmacy may file an appeal by
29following the appeal process as provided for in this Subpart. The pharmacy benefit
30manager shall respond to a challenge within fifteen business days after receipt of the
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1challenge.
2(2) The administrative appeal procedure shall allow a pharmacy or
3pharmacist the option to submit a consolidated appeal representing multiple
4substantially similar claims.
5*      *       *
6G. The commissioner may impose a reasonable fee upon pharmacy benefit
7managers, in accordance with the Administrative Procedure Act, in addition to a
8license fee and annual report fee, in order to cover the costs of implementation and
9enforcement of this Section and R.S. 22:1641 through 1657, 1851 through 1864, and
101961 through 1995 any portion of this Title pertaining to pharmacy benefit
11management, including fees to cover the cost of all of the following:
12*      *       *
13§1867.1 PBM duty; compensation; audits; contract and other requirements
14A. PBM Duty
15(1) Any pharmacy benefit manager doing business in this state shall act
16solely for the benefit of the health insurance issuers and health plans for which
17it provides pharmacy benefit management services and for the enrollees of the
18plans.
19(2) No pharmacy benefit manager, subsidiary, parent, or affiliate of such
20pharmacy benefit manager, either directly or indirectly, shall engage in any
21activity which increases the cost of prescription drugs to health insurance
22issuers, health plans, or enrollees; restricts or impairs access to prescription
23drugs except as directly required by the design of the health plan; or otherwise
24interferes with the obligation of the pharmacy benefit manager to act in the best
25interest of health insurance issuers, health plans, and enrollees.
26(3) A pharmacy benefit manager shall not:
27(a) Obtain a rebate, or any other incentive or inducement including but
28not limited to discounts, on a name brand drug in exchange for not placing
29other name brand drugs, biosimilars, generic drugs, or any other drug in the
30same class of drugs on the PBM formulary, unless returned to the health
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1insurance issuer or plan sponsor.
2(b) Design a prescription drug formulary to favor a certain branded
3pharmaceutical or biologic over a therapeutically equivalent generic or
4biosimilar, unless the branded pharmaceutical or biologic has a lower net
5acquisition cost and that lower cost is reflected in a lower out-of-pocket expense
6for consumers or lower premiums for enrollees.
7(c) Use its formulary to effectively ban the use of certain pharmacies by
8an insured.
9(4) Notwithstanding any other provision of law to the contrary, upon a
10determination that a pharmacy benefit manager has violated a provision of this
11Subsection, the commissioner may impose a fine in the amount of the greater
12of the cost to the health insurance issuer, health plan, or enrollees or the
13enrichment to the pharmacy benefit manager and any subsidiaries, parent, or
14affiliates thereof, plus an additional fine of twenty-five thousand dollars for each
15and every act or violation, with no aggregate penalty maximum.
16B. PBM Compensation
17(1) A pharmacy benefit manager or group purchasing organization may
18negotiate but shall not retain rebates and fees. All manufacturer rebates,
19whether accrued to a pharmacy benefit manager, a pharmacy benefit manager's
20affiliated group purchasing organization, or any other pharmacy benefit
21manager owned or affiliated entity shall be passed through to the pharmacy
22benefit manager's healthcare plan sponsor client as described in this Section.
23(2) A pharmacy benefit manager may earn income only from the
24following sources:
25(a) The assessment of a flat dollar service fee charged on a per-person
26per-month or a per-prescription or per-event basis which shall cover all of the
27pharmacy benefit manager's administrative, clinical, print, electronic, and
28related costs for the provision of prescription benefit management services to
29a client health benefit plan. The flat dollar service fee may vary among a
30pharmacy benefit manager's clients based on the number of health benefit plan
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1participants and clinical and administrative services provided, and shall be set
2forth in a written agreement between the parties.
3(b) A flat dollar performance bonus payment, which may be paid by a
4client health benefit plan to a pharmacy benefit manager for meeting specified
5benchmarks in reducing the client health benefit plan's aggregated overall drug
6spending over a specific period of time. A flat dollar performance bonus
7payment shall be set forth in a written agreement between the parties.
8(3) Pharmacy benefit management fees charged by or paid to a
9pharmacy benefit manager from a health insurance issuer or health plan shall
10not be directly or indirectly based or contingent upon any of the following:
11(a) The acquisition cost or any other price metric of a drug.
12(b) The amount of savings, rebates, or other fees charged, realized, or
13collected by or generated based on the activity of the pharmacy benefit
14manager.
15(c) The amount of premiums, deductibles, or other cost-sharing or fees
16charged, realized, or collected by the pharmacy benefit manager from patients
17or other persons on behalf of a patient.
18(4)(a) A pharmacy benefit manager shall not earn any income based
19directly on prescription drug list prices, acquisition cost, average wholesale cost,
20or any other metric for prescription drug pricing or fulfillment at any stage in
21the drug supply chain, including but not limited to prescription drug markups,
22up-charging, spread pricing of any kind, manufacturer-derived revenues of any
23sort, which shall include but not be limited to price protection, group
24purchasing organization retained rebates or fees of any kind, rebate aggregator
25administrative or any other fees charged or collected, coupon compensation and
26patient assistance compensation fees, retained discounts and rebates, and other
27manufacturer payments, and any other arrangements on price of prescription
28drugs.
29(b) Any prohibited pharmacy benefit manager income that a pharmacy
30manager may receive during the course of a pharmacy benefit manager's
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1operations in service of its Louisiana client health plans shall be considered
2prohibited income that the pharmacy benefit manager shall pass through in its
3entirety to the pharmacy benefit manager's Louisiana health benefit plan clients
4on a quarterly basis.
5(5) Annually by December thirty-first, each pharmacy benefit manager
6operating in the state shall certify to the commissioner that it has fully and
7completely complied with the requirements of this Subsection throughout the
8prior calendar year. The certification shall be signed by the chief executive
9officer or chief financial officer of the pharmacy benefit manager.
10C. PBM Audits
11(1) The commissioner and any health insurance issuer or health plan
12contracted with a pharmacy benefit manager holding a license issued by the
13commissioner may audit the pharmacy benefit manager once per calendar year.
14This audit right is in addition to, and shall not be construed to limit, any other
15audit rights authorized by law or contract. The commissioner may also examine
16the books or records of any entity in a pharmacy benefit manager's corporate
17vertical structure, including but not limited to the insurer, group purchasing
18organization, manufacturer, wholesale distributor, special or mail order
19pharmacy, retail or long-term care pharmacy, and provider. As part of any
20audit, the commissioner, health insurance issuer, or health plan may request
21information including but not limited to any of the following:
22(a) All reimbursement paid to retail pharmacies, on a claim level, for all
23customers of the pharmacy benefit manager in the state, including drug-specific
24reimbursement, dispensing fees, all rebates, other fees, ancillary charges,
25clawbacks, or adjustments to reimbursement.
26(b) Any difference in reimbursement paid to affiliated pharmacies and
27unaffiliated pharmacies, including differences in reimbursed ingredient costs
28and dispensing fees.
29(c) Historical claims data including ingredient cost, quantity, dispensing
30fee, sales tax, usual and customary price, channel such as mail or retail, health
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1insurance issuer or health plan paid amount, days' supply, the amount paid by
2the covered individual, formulary tier, acquisition cost, and any administrative
3fee associated with the claim, as applicable.
4(d) Aggregate rebate amounts received directly or indirectly from
5manufacturers, including from any other entity affiliated with or related to the
6pharmacy benefit manager that negotiates or contracts with manufacturers,
7such as group purchasing organizations and rebate aggregators, by calendar
8quarter.
9(2) The pharmacy benefit manager shall provide information pursuant
10to Paragraph (1) of this Subsection no later than thirty days after its receipt of
11any request from the commissioner, health insurance issuer, or health plan.
12(3) The commissioner may dictate the form in which the pharmacy
13benefit manager will provide information in response to an audit pursuant to
14Paragraph (1) of this Subsection.
15(4) The pharmacy benefit manager shall certify that all information
16submitted to the commissioner or any health insurance issuer or health plan in
17accordance with this Subsection is accurate and complete in all material
18respects. The certification shall be signed by the chief executive officer or chief
19financial officer of the pharmacy benefit manager.
20(5)(a) The commissioner and any health insurance issuer or health plan
21contracted with a pharmacy benefit manager holding a license issued by the
22commissioner shall not directly or indirectly publish or otherwise disclose any
23confidential, proprietary information, including but not limited to any
24information that would reveal the identity of a specific health plan or
25manufacturer, the price charged for a specific drug or class of drugs, the
26amount of any rebates provided for a specific drug or class of drugs, or that
27would otherwise have the potential to compromise the financial, competitive, or
28proprietary nature of the information. Any such information shall be protected
29as confidential and proprietary information, and is not a public record and is
30exempt from disclosure pursuant to the Public Records Law, R.S. 44:4.1 et seq.
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1The commissioner and any health insurance issuer or health plan contracted
2with a pharmacy benefit manager holding a license issued by the commissioner
3shall impose the confidentiality protections and requirements of this Paragraph
4on any agent or downstream third party that may receive or have access to this
5information.
6(b) Nothing in this Paragraph shall be construed to prohibit the
7commissioner from disclosing information to a Prescription Drug Affordability
8Board established pursuant to this Title if such information is subject to the
9confidentiality protections applicable to that board.
10D. PBM Contract and Other Requirements
11(1) A pharmacy benefit manager contract with a health insurance issuer
12or health plan entered into, amended, extended, or renewed on or after January
131, 2027, shall do both of the following:
14(a) Specify all forms of revenue, including pharmacy benefit
15management fees, to be paid by the health insurance issuer or health plan to the
16pharmacy benefit manager.
17(b) Acknowledge that spread pricing is not permitted in accordance with
18R.S. 22:1867.
19E.(1) In addition to any other penalty authorized by law, a violation of
20this Section shall be punishable by the commissioner through a civil monetary
21penalty of twenty-five thousand dollars for each and every act or violation, with
22no aggregate penalty maximum.
23(2) If a violation for which the commissioner has imposed a fine in
24accordance with this Subsection is not corrected within thirty days after notice
25of the violation is received by the pharmacy benefit manager, the commissioner
26shall suspend or revoke the pharmacy benefit manager's license in accordance
27with R.S. 49:977.3.
28F. In implementing the requirements of this Section, the state shall
29regulate a pharmacy benefit manager or health insurance issuer only to the
30extent permissible under applicable law.
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1G. The provisions of this Subpart shall apply only to the extent not
2preempted or otherwise prohibited by federal law. To the extent such conflict
3exists, the validity of the remainder of this Subpart and the applicability thereof
4to any other entity, person, or circumstance shall not be affected.
5H. Pharmacy Technology and Third Party Data Sharing
6(1) A pharmacy benefit manager, or any affiliate, subsidiary, or agent of
7a pharmacy benefit manager, shall not directly or indirectly prohibit or restrict
8a pharmacist or pharmacy from offering, directly or through a third party,
9services or products to increase transparency, access, and affordability of
10prescription drugs for patients. Such services and products include but are not
11limited to:
12(a) Simplified payment processes, electronic payments, or payment
13plans.
14(b) Adherence support services or communications.
15(c) Information regarding patient out-of-pocket costs or alternative
16medication options.
17(d) Electronic transactions that allow the pharmacist or pharmacy to
18provide patients with price and benefits transparency.
19(e) Sharing claims data or other healthcare transaction data of patients
20with the patient, the patient's healthcare providers, a business associate as that
21term is defined in 45 CFR 160.103, or any third party authorized by the patient
22at the time the pharmacist or pharmacy runs the claim or other electronic
23transaction or at any time thereafter.
24(f) Electronic transactions that allow the pharmacist or pharmacy to
25provide patients with prior authorization support to enable access to the
26patient's prescription drug.
27(g) Any lawful copayment assistance or other out-of-pocket support to
28patients to lower the costs of their prescription drugs.
29(2) A pharmacy benefit manager, or any affiliate, subsidiary, or agent of
30a pharmacy benefit manager, shall not directly or indirectly:
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1(a) Audit, investigate, terminate, or threaten to terminate a pharmacist
2or pharmacy from the pharmacy benefit manager's network as a result of the
3pharmacist or pharmacy engaging in any activity described in or allowed by
4Paragraph (1) of this Subsection.
5(b) Reduce, rescind, or otherwise claw back any reimbursement payment
6in whole or in part to a pharmacist or pharmacy for a prescriptions drug's
7ingredient cost or dispensing fee as a result of the pharmacist or pharmacy
8engaging in any activity described in or allowed by Paragraph (1) of this
9Subsection.
10(c) Discriminate against or otherwise penalize a pharmacist or
11pharmacy, including but not limited to decreasing any reimbursement rates or
12by reclassifying the pharmacist or pharmacy's class of trade as a result of the
13pharmacist or pharmacy engaging in any activity described in or allowed by
14Paragraph (1) of this Subsection.
15(3) Nothing in this Subsection shall be construed to modify or limit the
16application of R.S. 40:2870(A)(3) to a pharmacy benefit manager's handling of
17beneficiary personal health care or contact information. A pharmacy's sharing
18of claims data or other healthcare transaction data with a business associate, as
19that term is defined in 45 CFR 160.103, in compliance with the Health
20Insurance Portability and Accountability Act of 1996 and its implementing
21regulations, shall not constitute a pharmacy benefit manager buying, selling,
22transferring, or providing personal health care or contact information within
23the meaning of R.S. 40:2870(A)(3).
24(4) Any contract provision between a pharmacy benefit manager and a
25pharmacist or pharmacy that conflicts with this Subsection shall be severable
26from the contract and considered void and unenforceable in this state.
27(5) A violation of this Subsection is subject to the penalties provided in
28this Section.
29*        *     *
30§1868.2. Pharmacy benefit manager formularies
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1A. As used in this Section, the following terms have the following
2meanings:
3(1) "Affiliated manufacturer" means a drug or biological product
4manufacturer that, either directly or indirectly through one or more
5intermediaries, meets one or more of the following criteria:
6(a) Has an investment or ownership interest greater than five percent in
7a pharmacy benefit manager.
8(b) Shares common ownership with a pharmacy benefit manager.
9(c) Has an investor or a holder of an ownership interest in a pharmacy
10benefit manager.
11(2) "Biological product" has the same meaning as in the Public Health
12Service Act, 42 U.S.C. 262.
13(3) "Biosimilar" has the same meaning as in the Public Health Service
14Act, 42 U.S.C. 262.
15(4) "Interchangeable" has the same meaning as in the Public Health
16Service Act, 42 U.S.C. 262.
17B.(1) A pharmacy benefit manager revising the formulary of covered
18prescription drugs at the beginning of a plan year shall provide a sixty-day
19continuity-of-care period in which the covered prescription drug that is being
20revised from the formulary continues to be provided in the same formulary tier
21and cost-sharing structure for the period of sixty days.
22(2) The sixty-day continuity-of-care period commences upon notification
23to the insured by the insurer.
24(3) This Subsection does not apply if any of the following have occurred
25regarding the covered prescription drug:
26(a) The prescription drug has been made available over the counter by
27the United States Food and Drug Administration and has entered the
28commercial market as such.
29(b) The prescription drug has been removed or withdrawn from the
30commercial market by the manufacturer.
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1(c) The prescription drug is subject to an involuntary recall by state or
2federal authorities and is no longer available on the commercial market.
3C. A pharmacy benefit manager shall not require an insured to receive
4a drug or biological product that is manufactured by an affiliated manufacturer
5when there is an available generically equivalent drug, or an available biological
6product that is biosimilar to and interchangeable for the prescribed biological
7product.
8D. A pharmacy benefit manager shall not require an insured to receive
9a more expensive name brand drug when less expensive name brand drugs,
10biosimilars, generic drugs, or any other drug in the same class of drugs are
11available.
12E. Other than at the time of coverage renewal, while an insured is taking
13a prescription drug a pharmacy benefit manager shall not do any of the
14following:
15(1) Remove the prescription drug from its list of covered drugs during
16the policy year unless any of the following have occurred:
17(a) The United States Food and Drug Administration has issued a
18statement about the drug which calls into question the clinical safety of the
19drug.
20(b) The manufacturer of the drug has notified the United States Food
21and Drug Administration of a manufacturing discontinuance or potential
22discontinuance of the drug as required by the Federal Food, Drug, and
23Cosmetic Act, 21 U.S.C. 356c.
24(c) The drug has been approved and made available over the counter by
25the United States Food and Drug Administration and entered the commercial
26market as such.
27(2) Reclassify the drug to a more restrictive drug tier or increase the
28amount that an insured must pay for a copayment, coinsurance, or deductible
29for prescription drug benefits, or reclassify the drug to a higher cost-sharing
30tier during the policy year.
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1F. This Section does not prohibit the addition of prescription drugs to the
2formulary during the policy year.
3G. The provisions of this Subpart shall apply only to the extent not
4preempted or otherwise prohibited by federal law. To the extent such conflict
5exists, the validity of the remainder of this Subpart and the applicability thereof
6to any other entity, person, or circumstance shall not be affected.
7Section 2. R.S. 39:1600.1(A), the introductory paragraph of 1600.1(D), and
8 1600.1(D)(6) are hereby amended and reenacted to read as follows:
9§1600.1. Procurement of pharmacy benefit manager services by reverse auction
10A.(1) This section shall be known and may be cited as the "Louisiana
11Competitive Pharmacy Benefit Managers Act".
12(2) It is recommended to conduct the initial PBM reverse auction no later
13than July 1, 2028. Terms of any contract for pharmacy benefit services awarded
14through the initial reverse auction process may become effective at
15commencement of the new plan year beginning January 1, 2029.
16(3) It is recommended that PBM reverse auctions be conducted in
17accordance with the provisions of this Chapter at a frequency of no less than
18once every five years.
19*      *       *
20D. Contracts It is recommended that contracts for pharmacy benefit
21manager services obtained through reverse auction shall comply with the following:
22*      *       *
23(6)(a) With technical assistance and support provided by the technology
24platform provider, the division of administration shall specify the terms of the
25participant bidding agreement which shall not be modified except by specific consent
26of the division of administration.
27(b) It is recommended that the participant bidding agreement require
28qualified bidders in the PBM reverse auction process, both full service PBMs
29and carve-out service providers, to comply with the terms and provisions of all
30PBM regulations in Title 22 of the Louisiana Revised Statutes of 1950.
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1(c) It is recommended that qualified specialty carve-out prescription
2drug service providers compete with full service PBMs on the basis of price and
3any other appropriate criteria for award of a specialty drug contract over
4multiple rounds of dynamically competitive reverse auction bidding.
5(d) It is recommended that qualified generic carve-out prescription drug
6service providers compete with full service PBMs on the basis of price and any
7other appropriate criteria for award of a generic drug contract over multiple
8rounds of dynamically competitive reverse auction bidding.
9(e) The PBM reverse auction process may result in award of multiple or
10hybrid contracts to full service and carve-out prescription service providers if
11such award is determined to be of higher value to the state.
12*       *       *
13Section 3. R.S. 44:4.1(B)(11) is hereby amended and reenacted to read as follows:
14§4.1. Exceptions
15*       *       *
16B. The legislature further recognizes that there exist exceptions, exemptions,
17and limitations to the laws pertaining to public records throughout the revised
18statutes and codes of this state. Therefore, the following exceptions, exemptions, and
19limitations are hereby continued in effect by incorporation into this Chapter by
20citation:
21*       *       *
22(11) R.S. 22:2, 14, 31, 42.1, 88, 244, 263, 265, 461, 550.7, 550.22, 550.29,
23550.30, 571, 572, 572.1, 572.2, 574, 601.3, 618, 639, 691.4, 691.5, 691.6, 691.7,
24691.8, 691.9, 691.9.1, 691.10, 691.38, 691.56, 732, 752, 753, 771, 834, 972(D), 976,
251008, 1019.2, 1203, 1460, 1464, 1466, 1483.1, 1488, 1546, 1559, 1566(D), 1644,
261656, 1657.1, 1660.7, 1723, 1796, 1801, 1808.3, 1867.1, 1869, 1927, 1929, 1983,
271984, 2036, 2045, 2056, 2085, 2091, 2293, 2303, 2508
28*       *       *
29Section 4. R.S. 22:1868.1 and Section 5 of Act 474 of the 2025 Regular Session are
30 hereby repealed in their entirety.
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1Section 5. Sections 1 through 4 and 6 through 8 of this Act shall take effect and
2 become enforceable only if Section 4 of the Act which originated as Senate Bill No. 401 of
3 the 2026 Regular Session of the Legislature is enacted and becomes effective.
4Section 6. The provisions of this Act amending and reenacting R.S. 22:1856.1 and
5 1865 and enacting 1867.1(C) and 1867.1(E) and (F), shall become effective upon signature
6 of the governor or, if not signed by the governor, upon expiration of the time for bills to
7 become law without signature by the governor, as provided by Article III, Section 18 of the
8 Constitution of Louisiana. If vetoed by the governor and subsequently approved by the
9 legislature, these provisions of this Act shall become effective on the day following such
10 approval.
11Section 7. The provisions of this Act amending and reenacting R.S. 22:1863 and
12 enacting 1867.1(A)(1), (2), and (4) and (D) shall become effective on January 1, 2027.
13Section 8. The provisions of this Act amending and reenacting R.S. 39:1600.1(A) and
14 the introductory paragraph of 1600.1(D) and 1600.1(D)(6) and enacting 1867.1(A)(3) and
15 (B) and 1868.2 shall become effective on January 1, 2028.
  PRESIDENT OF THE SENATE
  SPEAKER OF THE HOUSE OF REPRESENTATIVES
  GOVERNOR OF THE STATE OF LOUISIANA
 APPROVED:
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