§450.7. Medicaid prescription drug benefit program
A.
(1)The Louisiana Department of Health, referred to hereafter in this Section as
the "department", shall administer the Medicaid prescription drug benefit program in
accordance with the authority provided for in this Section.
(2)The department is authorized to remove pharmacy services from Medicaid
managed care organization contracts and assume direct responsibility for all Louisiana
Medicaid pharmacy services. To comply with this Paragraph, the department may utilize
national best practices and techniques to assist with member medication adherence and to
control costs, including but not limited to implementation of a preferred drug list in
accordance with R.S. 46:153.3, utilization of medication therapy management in accordance
with R.
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§450.7. Medicaid prescription drug benefit program
A.(1) The Louisiana Department of Health, referred to hereafter in this Section as
the "department", shall administer the Medicaid prescription drug benefit program in
accordance with the authority provided for in this Section.
(2) The department is authorized to remove pharmacy services from Medicaid
managed care organization contracts and assume direct responsibility for all Louisiana
Medicaid pharmacy services. To comply with this Paragraph, the department may utilize
national best practices and techniques to assist with member medication adherence and to
control costs, including but not limited to implementation of a preferred drug list in
accordance with R.S. 46:153.3, utilization of medication therapy management in accordance
with R.S. 46:153.3.1, and other clinically effective cost-efficient options allowed by state and
federal law.
(3) If the department does not exercise the authority provided for in Paragraph (2)
of this Subsection and administers the Medicaid pharmacy program through use of one or
more Medicaid managed care organization pharmacy benefit managers, the pharmacy benefit
manager shall be reimbursed a transaction fee only and shall not retain any portion of spread
pricing or state supplemental rebates, as set forth in R.S. 39:1648. In addition, a Medicaid
managed care organization or a Medicaid managed care organization pharmacy benefit
manager shall not do any of the following:
(a) Buy, sell, transfer, or provide Medicaid recipient personal healthcare or contact
information to any other party, including subsidiaries of the pharmacy benefit manager, for
any purpose unless specifically authorized to do so by the department, and under no
circumstance may such activity be for the purpose of patient steering. For purposes of this
Subparagraph, "patient steering" means encouraging or enticing of any Medicaid recipient
to switch to any pharmacy, including a mail-order pharmacy, through unsolicited advice or
mass-marketing directed at a Medicaid recipient by a pharmacy benefit manager, including
any employees, affiliated providers, agents, or contractors of the pharmacy benefit manager,
that is intended to influence or that can reasonably be concluded to influence the Medicaid
recipient to change pharmacies.
(b) Deny any Louisiana-licensed pharmacy or Louisiana-licensed pharmacist the
right to be a participating provider in the managed care organization pharmacy benefit
manager's provider network if the pharmacy or pharmacist meets all requirements of
participation in the state Medicaid program.
(c) Deduct healthcare provider fees due to the state pursuant to R.S. 46:2625 from
any amount due as reimbursement to a pharmacist or pharmacy.
(d) Deduct sales taxes owed to any taxing authority imposing the sales tax pursuant
to R.S. 47:337.11.1 from any amount due as reimbursement to a pharmacist or pharmacy.
B. The department has a duty to administer the Medicaid prescription drug benefit
program in the most clinically effective and cost-efficient manner possible. To ensure
compliance with this duty, the department shall develop a comprehensive plan to administer
the Medicaid prescription drug program and submit the plan to the Senate Committee on
Health and Welfare, Senate Committee on Finance, House Committee on Health and
Welfare, and House Committee on Appropriations on or before February 1, 2020. At a
minimum, the comprehensive plan shall include the following:
(1) Best practices and clinical and cost outcomes from other states that have removed
pharmacy services from Medicaid managed care organization contracts and assumed direct
administrative responsibility.
(2) Managed care organization portal access to ensure coordination of patient care
if pharmacy services are removed from Medicaid managed care organization contracts.
(3) Maximum rebate utilization through participation in the most effective bulk
purchasing multi-state buying pool.
(4) Medicaid managed care organization use of a pharmacy benefit manager for
Medicaid prescription drug benefit program administration if the pharmacy benefit manager
is part of a larger company that also owns retail pharmacies.
C. 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.