§ 40:2870 — Prohibited acts; unfair and deceptive trade practices

Louisiana § 40:2870

• Jurisdiction: Louisiana
• Title 40: Public Health and Safety

Text

§2870. Prohibited acts; unfair and deceptive trade practices
A. A pharmacy benefit manager in Louisiana shall not:
(1) Commit any unfair and deceptive trade practice prohibited by R.S. 22:1964(15).
(2) Perform any act that violates the duties, obligations, and responsibilities imposed
under the Louisiana Insurance Code on a pharmacy benefit manager.
(3) Buy, sell, transfer, or provide personal healthcare or contact information of any
beneficiary to any other party for any purpose with one exception. A pharmacy benefit
manager may provide such information regarding beneficiaries of a health plan to that health
plan provider if requested by the health plan provider.
(4) Conduct or participate in effective rate pricing or spread pricing.
(5)(a) Directly or indirectly engage in patient steering to a pharmacy in which the
pharmacy benefit manager maintains an ownership interest or control. Patient steering
includes but is not limited to any communication by a pharmacy benefit manager through
data mining or other similar process of any patient information generated or obtained
throughout the prescription filling process at any pharmacy, including contacting the patient
verbally or in writing to directly or indirectly influence the patient or provide the patient with
the option to use an alternate pharmacy that is a preferred carve-out or is in a strategic
relationship with the pharmacy benefit manager or in which the pharmacy benefit manager
maintains an ownership interest or control or contracts with to process prescriptions on its
behalf. A pharmacy benefit manager is prohibited from retaliation or attempts to influence
the patient to use the alternate pharmacy.
(b) Repealed by Acts 2025, No. 474, §4, eff. June 20, 2025.
(6)(a) Penalize a beneficiary or provide an inducement to the beneficiary for the
purpose of getting the beneficiary to use specific retail, mail order pharmacy, or another
network pharmacy provider in which a pharmacy benefit manager has an ownership or
controlling interest or that has an ownership or controlling interest in a pharmacy benefit
manager.
(b) For purposes of this Paragraph, "inducement" means the providing of financial
incentives, including variations in premiums, deductibles, copayments, or coinsurance.
(c) The provisions of this Paragraph shall not apply to employers, unions,
associations, or other persons who employ, own, operate, control, or contract directly with
a pharmacy or pharmacist for the purpose of managing or controlling prescription costs paid
for the benefit of an employee or member or those covered by the employee or member's
plan, or when the persons contract with a pharmacy benefit manager to steer employees or
members to pharmacists or pharmacies which the person owns, operates, or controls.
(7) Retroactively deny or reduce a claim of a pharmacist or pharmacy for payment
or demand repayment of all or part of a claim after the claim has been approved by the
pharmacy benefit manager as authorized by R.S. 22:1856.1.
(8) Reimburse a local pharmacist or local pharmacy, as defined in R.S.
46:460.36(A), less than the amount it reimburses chain pharmacies, mail-order pharmacies,
specialty pharmacies, or affiliates of the pharmacy benefit manager for the same drug or
device or for the same pharmacy service in this state.
(9) Fail to update prices as required by R.S. 22:1857.
(10)(a) Fail to honor maximum allowable cost (MAC) prices as set forth in R.S.
22:1863 et seq.
(b) A pharmacy benefit manager shall not require a pharmacist or pharmacy to
purchase drugs from any particular wholesaler. However, if a pharmacy benefit manager
recommends or provides a wholesaler, then that wholesaler must be willing and able to honor
the pharmacy benefit manager's MAC price, ship the order, and have receipt of the order
within two business days with no additional charge to the pharmacist.
(c) The wholesaler with the lowest price, which is listed as the MAC price, is not
obligated to sell or ship to a nonmember pharmacist or pharmacy. If the wholesaler chooses
not to sell the drug to the pharmacist or pharmacy, then the MAC price set by the pharmacy
benefit manager must be adjusted to the price available to the pharmacist or pharmacy
through another wholesaler.
(11) Fail to meet the payment standards established in R.S. 22:1856.
(12) Fail to provide detailed remittance advice to pharmacists and pharmacies in
compliance with R.S. 22:1856.
(13)(a) Fail to pay any state or local sales tax imposed on any drug, device, or
pharmacy services or to remit the sales tax to the appropriate pharmacist or pharmacy for the
tax proceeds to be forwarded to the sales tax authority.
(b) A pharmacy benefit manager who does not pay the sales tax shall be liable to the
taxing authority for the tax, interest, penalties, and any other fees or costs imposed by law
for failure to pay sales taxes.
(c) No pharmacy benefit manager shall deduct the taxes from any amount due to a
pharmacist or pharmacy for a drug, device, or pharmacy service or charge or pay anyone a
fee or surcharge for paying any sales tax or remitting any sales tax proceeds to a pharmacist
or pharmacy if that fee or surcharge would be imposed directly or indirectly on the
pharmacist or pharmacy.
(d) All pharmacy benefit managers who pay any out-of-state pharmacist or pharmacy
for drugs or devices shipped to a beneficiary in this state or for pharmacy services rendered
to a beneficiary which is taxable in this state shall remit the tax directly to the appropriate
taxing authority.
(e) Any pharmacist or pharmacy who does not receive sales tax proceeds from a
pharmacy benefit manager for any drug, device, or pharmacy service which is subject to sales
taxes shall have no responsibility for payment of the taxes if the pharmacist or pharmacy
provides written notification to the appropriate taxing authority, the Department of Insurance,
and the Board of Pharmacy of the pharmacy benefit manager's failure to remit the sales taxes
at the time the next sales tax return is due to be filed.
(f) State or local sales taxes and other applicable state-imposed taxes or fees shall
be considered as part of the allowable cost and shall be included in the claim submitted by
a pharmacist or pharmacy.
(14) Restrict early refills on maintenance drugs to an amount less than seven days
for a prescription of at least a thirty-day supply. However, at the direction of the Louisiana
Department of Health, for purposes of administering the Medicaid pharmacy benefit
program, a pharmacy benefit manager may apply a more restrictive early refill policy without
violating the provisions of this Paragraph.
(15) Require a beneficiary to follow a plan's step therapy protocol if the prescribed
drug is on the health plan's prescription drug formulary, the beneficiary has tried the step
therapy required prescription drug while under his current or previous health plan, and the
provider has submitted a justification and supporting clinical documentation that such
prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect,
or an adverse effect or event.
(16) Delay a decision on a request for authorization to dispense a prescription drug
for more than seventy-two hours, or twenty-four hours in exigent circumstances in which the
patient, in the opinion of the prescribing provider, pharmacy, or pharmacist submitting the
authorization request, is suffering from a health condition that may seriously jeopardize the
patient's life, health, or ability to regain maximum function. A request for authorization shall
include relevant data or appropriate documentation to render a decision on a request for
authorization.
(17) Exploit prescription drug information obtained from beneficiaries for monetary
gain or economic power over beneficiaries, pharmacists, or pharmacies.
(18) Sell, exchange, or use in any manner prescription drug information regarding
a beneficiary obtained through a beneficiary's use of a prescription for purposes of marketing,
solicitation, consumer steering, referral, or any other practice or act, except as otherwise
provided for in this Section, that provides the pharmacy benefit manager or any of its
affiliates or subsidiaries economic power or control over pharmacists or pharmacies or
interferes in the free choice of a beneficiary.
(19) Engage in drug repackaging and markups. A pharmacy benefit manager that
owns or controls a mail-order pharmacy shall not allow the mail-order pharmacy to
repackage drugs and sell the repackaged items at higher prices than the original average
wholesale price unless beneficiaries who may buy the repackaged drugs are informed in
writing that the drugs have been repackaged and are being sold at the higher price.
(20) Operate in Louisiana without either being registered with and in good standing
with the Louisiana secretary of state to do business in Louisiana or being licensed by and in
good standing with the commissioner of insurance, as provided by this Chapter.
B.(1) The commission of any of the acts or any combination of acts prohibited by
this Section shall be considered an unfair method of competition and unfair practice or act
in accordance with the Unfair Trade Practices and Consumer Protection Law, R.S. 51:1401
et seq., if the violations are committed or performed with such frequency as to indicate a
general business practice. Notwithstanding any provision of law to the contrary, the private
right of action created by R.S. 51:1409 shall not apply to this Section.
(2) For purposes of this Section, a violation shall be considered to have occurred
each time a prohibited act is committed.
(3) Each day that a pharmacy benefit manager operates without being registered with
and in good standing with the secretary of state to do business in Louisiana or without being
licensed by and in good standing with the commissioner of insurance, as provided by this
Chapter, shall be considered a separate violation.
C.(1) Nothing in this Section shall be construed to interfere with or violate a
consumer's right to know where the consumer may have access to the lowest cost drugs,
whether a consumer is utilizing insurance or other third-party reimbursement or not.
(2) Nothing in this Section shall be construed to interfere with the requirement that
consumers receive notice of changes to pharmacy networks, such as the inclusion of new
pharmacies or removal of existing pharmacies from networks.

Legislative History

Acts 2019, No. 124, §3, eff. July 1, 2020; Acts 2025, No. 474, §§2, 4, eff. June 20, 2025.