RS 39:1648

SUBPART L. MEDICAID MANAGED CARE §1648. Medicaid contracts or subcontracts for pharmacy benefit manager services A. Contracts for pharmacy benefit manager services, either directly with the Louisiana Department of Health or as a subcontractor or subsidiary of a managed care organization that has a contract with the Louisiana Department of Health, shall be awarded based only on the following provisions: (1) Any contract for pharmacy benefit manager services shall be limited to a transaction fee only, based on a set rate established by the Louisiana Department of Health to be paid to the pharmacy benefit manager for each Medicaid pharmacy claim processed. (2) No pharmacy benefit manager may retain any portion of state supplemental rebates or credits submitted to the state by any pharmaceutical manufacturer. (3) No pharmacy benefit manager may retain any portion of "spread pricing". For purposes of this Section, "spread pricing" shall mean any amount charged or claimed by a pharmacy benefit manager to a managed care organization that is in excess of the amount paid to the pharmacy that filled the prescription. B. Any Louisiana Department of Health contract in existence on August 1, 2018, with a pharmacy benefit manager or with a managed care organization that subcontracts or has a subsidiary pharmacy benefit manager may be amended to comply with the provisions of this Section. The department may terminate the contract with any managed care organization or pharmacy benefit manager who is not willing to amend their contract to comply with the provisions of this Section, and the provision of this service shall be opened for bid to other pharmacy benefit managers in accordance with the Louisiana Procurement Code, R.S. 39:1551 et seq. C.(1) After August 1, 2018, any subsequent requests for proposal issued by the Louisiana Department of Health for Medicaid managed care organization services that include the provision of pharmacy or pharmacy benefit manager services shall include the provisions of Subsection A of this Section. (2) The Louisiana Department of Health may procure and negotiate pharmacy benefit manager contracts through the use of a reverse auction pursuant to R.S. 39:1600(D) and 1600.1 and the requirements of this Section. D. No pharmacy benefit manager or Medicaid managed care organization that subcontracts or has a subsidiary pharmacy benefit manager shall deny any Louisiana licensed pharmacy or Louisiana licensed pharmacist the right to be a participating provider in the managed care organization or pharmacy benefit manager's provider network if the pharmacy or pharmacist meets all requirements of participation in the state Medicaid program. E. The Louisiana Department of Health shall promulgate rules as may be necessary to comply with the provisions of this Section in accordance with the Administrative Procedure Act, R.S. 49:950 et seq. Acts 2018, No. 483, §1; Acts 2021, No. 102, §2.