§976. Disclosure of prescription drug consumer cost burden; certification
A. As used in this Section:
(1)"Excess consumer cost burden" means an amount charged to an enrollee for a
covered prescription drug that is greater than the amount that an enrollee's health insurance
issuer pays, or would pay absent the enrollee cost sharing, after accounting for an issuer's
estimate of at least fifty percent of future rebate payments for that enrollee's actual point of
sale prescription drug claim.
(2)"Health benefit plan", "plan", "benefit", or "health insurance coverage" means
services consisting of medical care provided directly through insurance, reimbursement, or
other means, and including items and services paid for as medical care under any hospital or
medical service policy or certificate,
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§976. Disclosure of prescription drug consumer cost burden; certification
A. As used in this Section:
(1) "Excess consumer cost burden" means an amount charged to an enrollee for a
covered prescription drug that is greater than the amount that an enrollee's health insurance
issuer pays, or would pay absent the enrollee cost sharing, after accounting for an issuer's
estimate of at least fifty percent of future rebate payments for that enrollee's actual point of
sale prescription drug claim.
(2) "Health benefit plan", "plan", "benefit", or "health insurance coverage" means
services consisting of medical care provided directly through insurance, reimbursement, or
other means, and including items and services paid for as medical care under any hospital or
medical service policy or certificate, hospital or medical service plan contract, preferred
provider organization contract, or health maintenance organization contract offered by a
health insurance issuer. However, excepted benefits are not included as a "health benefit
plan".
(3) "Health insurance issuer" means any entity that offers health insurance coverage
through a plan, policy, or certificate of insurance subject to state law that regulates the
business of insurance. "Health insurance issuer" shall also include a health maintenance
organization, as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this
Code. "Health insurance issuer" shall not include the Office of Group Benefits.
(4) "Rebates" means both of the following:
(a) Negotiated price concessions, including but not limited to base rebates and
reasonable estimates of any price protection rebates and performance-based rebates that may
accrue directly or indirectly to the health insurance issuer as a result of point of sale
prescription drug claims processing during the coverage year from a manufacturer,
dispensing pharmacy, or other party to the transaction.
(b) Reasonable estimates of any fees and other administrative costs that are passed
through to the health insurance issuer as a result of point of sale prescription drug claims
processing and serve to reduce the health insurance issuer's prescription drug liabilities for
the coverage year.
B. In the case of a health insurance issuer that offers or renews a health benefit plan
for sale in the state on or after January 1, 2020, if the health insurance issuer may charge
enrollees cost-sharing amounts that may result in an excess consumer cost burden for
covered prescription drugs, the health insurance issuer shall disclose to enrollees and
prospective enrollees the fact that enrollees may be subject to an excess consumer cost
burden. The notice shall be provided in the coverage agreement, formulary, or preferred drug
guide issued by the health plan.
C. A health insurance issuer that offers or renews a health benefit plan for sale in the
state on or after January 1, 2020, shall annually make available to the commissioner of
insurance information regarding the value of rebates expressed as a percentage that the health
insurance issuer made available to enrollees at the point of sale.
D. In complying with the provisions of this Section a health insurance issuer shall not
publish or otherwise reveal information regarding the actual amount of rebates the health
insurance issuer receives, including but not limited to information regarding the amount of
rebates it receives on a product, manufacturer, or pharmacy specific basis. Such information
is a trade secret, is not a public record as defined in R.S. 44:1 et seq., and shall not be
disclosed directly or indirectly. A health insurance issuer shall impose the confidentiality
protections of this Section on any third parties or vendors with which it contracts that may
receive or have access to rebate information.
Acts 1990, No. 131, §1, eff. Sept. 1, 1990; Acts 1991, No. 574, §1, eff. July 16, 1991;
Acts 1993, No. 191, §1; Redesignated from R.S. 22:213.2 by Acts 2008, No. 415, §1, eff.
Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011; Acts 2013, No. 325, §2, eff. Dec. 31,
2014; Acts 2018, No. 579, §1.