§2883. Prohibition of certain discriminatory actions related to reimbursement of 340B
entities
A.
(1)With respect to reimbursement to a 340B entity for 340B drugs, a health
insurance issuer, pharmacy benefit manager, other third-party payor, or its agent shall not do
any of the following:
(a)Reimburse a 340B entity for 340B drugs at a rate lower than that paid for the
same drug to entities that are not 340B entities or lower reimbursement for a claim on the
basis that the claim is for a 340B drug.
(b)Impose any terms or conditions on any 340B entity with respect to any of the
following that differ from such terms or conditions applied to non-340B entities on the basis
that the entity participates in the federal 340B drug discount program set forth in 42 U.S.C.
256b or that a drug is a 34 Free access — add to your briefcase to read the full text and ask questions with AI
§2883. Prohibition of certain discriminatory actions related to reimbursement of 340B
entities
A.(1) With respect to reimbursement to a 340B entity for 340B drugs, a health
insurance issuer, pharmacy benefit manager, other third-party payor, or its agent shall not do
any of the following:
(a) Reimburse a 340B entity for 340B drugs at a rate lower than that paid for the
same drug to entities that are not 340B entities or lower reimbursement for a claim on the
basis that the claim is for a 340B drug.
(b) Impose any terms or conditions on any 340B entity with respect to any of the
following that differ from such terms or conditions applied to non-340B entities on the basis
that the entity participates in the federal 340B drug discount program set forth in 42 U.S.C.
256b or that a drug is a 340B drug including, without limitation, any of the following:
(i) Fees, charges, clawbacks, or other adjustments or assessments. For purposes of
this Subsection, the term "other adjustment" includes placing any additional requirements,
restrictions, or unnecessary burdens upon the 340B entity that results in administrative costs
or fees to the 340B entity that are not placed upon other entities that do not participate in the
340B drug discount program, including affiliate pharmacies of the health insurance issuer,
pharmacy benefit manager, or other third-party payor.
(ii) Dispensing fees that are less than the dispensing fees for non-340B entities.
(iii) Restrictions or requirements regarding participation in standard or preferred
pharmacy networks.
(iv) Requirements relating to the frequency or scope of audits of inventory
management systems.
(v) Requirements that a claim for a drug include any identification, billing modifier,
attestation, or other indication that a drug is a 340B drug in order to be processed or
resubmitted unless it is required by the Centers for Medicare and Medicaid Services or the
Louisiana Department of Health for the administration of the Louisiana Medicaid program.
(vi) Any other restrictions, conditions, practices, or policies that are not imposed on
non-340B entities.
(c) Require a 340B entity to reverse, resubmit, or clarify a claim after the initial
adjudication unless these actions are in the normal course of pharmacy business and not
related to 340B drug pricing.
(d) Discriminate against a 340B entity in a manner that prevents or interferes with
any patient's choice to receive such drugs from the 340B entity, including the administration
of such drugs. For purposes of this Subsection, it is considered a discriminatory practice that
prevents or interferes with a patient's choice to receive drugs at a 340B entity if a health
insurance issuer, pharmacy benefit manager, or other third-party payor places any additional
requirements, restrictions, or unnecessary burdens upon the 340B entity that results in
administrative costs or fees to the 340B entity, including but not limited to requiring a claim
for a drug to include any identification, billing modifier, attestation, or other indication that
a drug is a 340B drug in order to be processed or resubmitted unless it is required by the
Centers for Medicare and Medicaid Services or the Louisiana Department of Health in
administration of the Louisiana Medicaid program.
(e) Include any other provision in a contract between a health insurance issuer,
pharmacy benefit manager, or other third-party payor and a 340B entity that discriminates
against the 340B entity or prevents or interferes with an individual's choice to receive a
prescription drug from a 340B entity, including the administration of the drug, in person or
via direct delivery, mail, or other form of shipment, or creation of a restriction or additional
charge on a patient who chooses to receive drugs from a 340B entity.
(f) Require or compel the submission of ingredient costs or pricing data pertaining
to 340B drugs to any health insurance issuer, pharmacy benefit manager, or other third-party
payor.
(g) Exclude any 340B entity from the health insurance issuer, pharmacy benefit
manager, or other third-party payor network on the basis that the 340B entity dispenses drugs
subject to an agreement under 42 U.S.C. 256b, or refusing to contract with a 340B entity for
reasons other than those that apply equally to non-340B entities.
B. Nothing in this Chapter applies to the Louisiana Medicaid program as payor when
Medicaid provides reimbursement for covered outpatient drugs as defined in 42 U.S.C.
1396r-8(k)).