Gov. Jeff Landry (R) signed into law HB 1236, legislation creating a commercial market reimbursement floor and seeking to prevent PBMs from unnecessarily passing costs to patients, as seen in other states. Now known as Act 913, the law requires:
- NADAC as the reimbursement benchmark, but if NADAC is less than what the pharmacy actually paid for the drug, as documented by wholesaler or manufacturer invoice, the PBM must pay the difference up to acquisition cost.
- Requires all PBMs to also include the professional dispensing fee established by the Louisiana Medicaid rate, currently $11.81, in each commercial claim reimbursement.
- Requires that PBMs reprocess all claims between Jan. 1 and June 12, 2026, with the $9.00 dispensing fee per the Department of Insurance’s existing standard.
Other notable provisions in Act 913 include:
- The PBM is prohibited from amending or changing the amount a prescription drug consumer must pay for an out-of-pocket cost share or expense.
- The bill tightens up the language prohibiting PBMs from passing the dispensing fee onto patients, pharmacies, or pharmacists. Nothing in the act prohibits the PBM from passing this on to the plan or negotiating with the plan. This is specifically to address any ERISA preemption arguments or questions related to “plan design interference” that would hold up the law in court.
- The appeals process continues to require PBMs to reimburse up to acquisition cost on a successful appeal and prohibits shifting that increase to the patient's copay.
Congratulations to the Louisiana Independent Pharmacies Association (LIPA) for this fantastic legislative victory! NCPA joins LIPA in hailing Rep. Jason Dewitt (R-25) for his strong leadership on the bill and Landry for his ongoing support.
NCPA
