LouisianaManagers use drug price benchmarks and pay pharmacy dispensing fees
For covered local pharmacy claims, managers use set drug price benchmarks and pay a dispensing fee, with a separate rule for claims reprocessed back to January 1, 2026.
What it does
Managers use NADAC as the drug price benchmark for covered local pharmacy claims, or wholesale acquisition cost when NADAC is unavailable. The commissioner may approve another benchmark under stated error limits.
Managers pay a dispensing fee at least as high as the Louisiana Medicaid fee and cannot recover it from pharmacies, pharmacists, or members. To meet the retroactive rule, they must reprocess applicable claims using a fee of at least $9.
The insurance commissioner may require managers to provide claim details, such as payment amounts and dispensing fees, to check whether they follow the reimbursement rules.
Argument forWhen a claim is underpaid, a pharmacy could receive an added payment up to its drug acquisition cost, helping cover what it paid for the drug.
Argument againstManagers could face higher costs because they must pay a dispensing fee and cannot recover it from pharmacies, pharmacists, or members.
More detail
Pharmacy benefit managers use NADAC as the drug price benchmark, or wholesale acquisition cost when NADAC is unavailable. The rule covers local pharmacy claims handled by a manager for a health plan, except claims for the Office of Group Benefits. With the commissioner's prior written approval, a manager may use another benchmark if its payment errors are no more frequent and are smaller than those under NADAC. The Office of Group Benefits is excluded. The rule applies beginning January 1, 2026.
Pharmacy benefit managers pay a professional dispensing fee at least as high as the fee set for Louisiana Medicaid and cannot recover that fee from pharmacies, pharmacists, or members. The fee applies to local pharmacy claims covered by the reimbursement rules, except claims for the Office of Group Benefits. For retroactive compliance, a manager must reprocess applicable claims using the required benchmark and a fee of at least $9. Meeting the retroactive compliance rule does not establish compliance with the prospective requirements. The retroactive rule for the fee applies from January 1, 2026. All other provisions apply prospectively.
The insurance commissioner may require pharmacy benefit managers to submit claim-level information to check compliance. The authority applies to pharmacy benefit managers subject to this section. The information may include reimbursement amounts, dispensing fees, and adjustments. The text gives no separate start date for this authority.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 12Signed by the Governor Jeff Landry. Becomes Act No. 913.Became Law
- Jun 12Effective date: 06/12/2026.
- Jun 4Sent to the Governor for executive approval.To Governor
- Jun 1Enrolled and signed by the Speaker of the House.Minor
- Jun 1Signed by the President of the Senate.
- May 31Conference Committee Report read, roll called, yeas 93, nays 0. The Conference Committee Report was adopted.
- Vote recorded ADOPT CONFERENCE REPORT (#1791). Result: pass.Lower
- Vote recorded ADOPT (#1605). Result: pass.Upper
- May 31Notice House adopted the Conference Committee Report.
- May 31Conference Committee Report read; adopted by a vote of 35 yeas and 0 nays.
- May 31Notice of Senate adoption of Conference Committee Report.
- May 29Conference committee report received.
- May 29Conference Committee report received. Lies over under the rules.
- May 29Scheduled for floor debate on 05/31/2026.
- May 27House conferees appointed: Dewitt, Firment, and Miller.
- May 27Notice House Conference Committee members appointed.
- May 26Read by title, roll called, yeas 99, nays 0, Senate amendments rejected, conference committee appointment pending.
- Vote recorded REJECT SENATE AMENDMENTS (#1491). Result: pass.Lower
- May 26Notice House rejected the Senate amendments.
- May 26Senate conference committee members appointed: Talbot, Bass, and Harris.
- May 26Notice of Senate conferees appointed.
- May 25Scheduled for concurrence on 05/26/2026.
- May 20Received from the Senate with amendments.Minor
- May 19Rules suspended. Read by title, passed by a vote of 34 yeas and 0 nays, and ordered returned to the House. Motion to reconsider tabled.Passed Senate
- Vote recorded FINAL PASSAGE (#1019). Result: pass.Upper
- May 13Reported without Legislative Bureau amendments. Read by title and passed to third reading and final passage.Minor
- May 12Read by title and referred to the Legislative Bureau.
- May 11Reported favorably.Minor
- May 7Senate Committee amendments read and adopted.
- May 7Read by title. Recommitted to the Committee on Finance.
- May 6Reported with amendments.Minor
- Apr 27Read second time by title and referred to the Committee on Insurance.Minor
- Apr 22Received in the Senate. Read first time by title and placed on the Calendar for a second reading.Minor
- Apr 21Called from the calendar.
- Vote recorded FINAL PASSAGE (#642). Result: pass.Lower
- Apr 21Read third time by title, amended, roll called on final passage, yeas 102, nays 0. Finally passed, title adopted, ordered to the Senate.Passed House
- Apr 20Notice given.
- Apr 20Scheduled for floor debate on 04/21/2026.
- Apr 15Read by title, returned to the calendar.
- Apr 14Scheduled for floor debate on 04/15/2026.
- Apr 13Read by title, ordered engrossed, passed to 3rd reading.Minor
- Apr 9Read by title, substitute title adopted, lies over in the same order of business, substitute for HB No. 866 reported by the Committee on Insurance (12-0).Introduced
Healthcare