§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.
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§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.