Louisiana § RS 22:1868.1 - Pharmacy benefit manager rebate retention restrictions; fee disclosure

§ RS 22:1868.1. Pharmacy benefit manager rebate retention restrictions; fee disclosure

            A. A pharmacy benefit manager may negotiate, but shall not retain any portion of rebates received from a drug manufacturer. All manufacturer rebates shall be passed through to the plan sponsor as shared savings in the form of lower premiums, reduced cost-sharing including reduced copays, coinsurance, or deductibles for prescription drugs, or to provide broader drug coverage. The specific allocation of rebates and how they are shared with plan members shall be identified in the plan sponsor's plan design and contract terms.

            B. All pharmacy benefit management fees shall be disclosed in writing and set forth clearly in the contract between the pharmacy benefit manager and the insurer or health plan.

            C. On or before December thirty-first of each calendar year, each pharmacy benefit manager shall certify under oath to the commissioner of insurance that it has fully complied with the provisions of this Section for the prior calendar year. The certification shall be signed by the chief executive officer or chief financial officer of the pharmacy benefit manager and shall be subject to audit and penalty for false statements.

            D. Any violation of this Section shall be considered an unfair or deceptive act or practice in the business of insurance and shall be subject to all enforcement authority granted to the commissioner pursuant to this Title.

            E. For purposes of this Section, the following definitions apply:

            (1) "Pharmacy benefit management fee" means a fee paid by an insurer or health plan to a pharmacy benefit manager for pharmacy benefit management services provided.

            (2) "Rebates" means all rebates, discounts, and other price concessions, based on utilization of a prescription drug and paid by the manufacturer or other party other than an enrollee, directly or indirectly, to the pharmacy benefit manager after the claim has been adjudicated at the pharmacy. Rebates shall include a reasonable estimate, as determined by the commissioner, of any volume-based discount or other discounts.

            Acts 2025, No. 474, §1, eff. June 20, 2025.