Louisiana § RS 42:813 - Definitions

§ RS 42:813. Definitions

            For the purposes of this Subpart, the following terms shall have the following meanings:

            (1) "Administrative fee" means the sole compensation that the administrator or pharmacy benefit manager receives under the contract. The administrative fee includes all services related to the contract including but not limited to appeals, clinical programs, and other communications, eligibility maintenance, explanation of benefits, formulary customizations, member grievances and call centers, on-site audits and surveys, prior authorizations and step therapy, trend management, and benchmark reporting and transaction fees. The administrative fee does not include pass-through claims.

            (2) "Administrator" means any entity contracted with the office to adjust or settle claims in connection with health coverage offered by the office. The term "administrator" shall not include an employer performing any such service on behalf of its employees, an independent consulting actuary contracted with the office, or a pharmacy benefit manager.

            (3) "Pharmacy benefit manager" means any entity contracted with the office to administer a prescription drug or device program of one or more health plans on behalf of the office in accordance with a pharmacy benefit program.

            (4) "Revenues" means all financial benefits that an administrator or pharmacy benefit manager receives related to utilization or enrollment in programs offered by the office. These include but are not limited to access fees, market share fees, formulary access fees, inflation protection and penalty payments, and marketing grants from pharmaceutical manufacturers, wholesalers, and data warehouse vendors. "Revenues" also means any financial benefit received by an administrator or pharmacy benefit manager attached to a rebate.

            Acts 2024, No. 546, §1, eff. July 1, 2024.