Louisiana enacted legislation June 12 establishing new commercial reimbursement requirements for pharmacy benefit managers. The law creates a commercial market reimbursement floor and includes provisions intended to prevent PBMs from shifting costs to patients.
Act 913, signed into law June 12, requires PBMs to use the National Average Drug Acquisition Cost (NADAC) as the reimbursement benchmark. If the NADAC is lower than a pharmacy’s documented acquisition cost. The law also requires PBMs to include the Louisiana Medicaid professional dispensing fee, currently $11.81, in each commercial claim reimbursement.
In addition, the law requires PBMs to reprocess commercial claims between Jan. 1 and June 12, 2026, using a $9 dispensing fee under the Louisiana Department of Insurance’s existing standard. The legislation also prohibits PBMs from changing a patient’s out-of-pocket cost sharing, strengthens language prohibiting PBMs from passing dispensing fees to patients, pharmacies or pharmacists, and maintains an appeals process requiring reimbursement up to acquisition cost on successful appeals without increasing a patient’s copayment.
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