Louisiana

SUMMARY

Louisiana passed a number of legislation during the 2018 session to promote transparency in healthcare and curb healthcare costs. The Legislature passed the Pharmacist Communication with Patients Act (SB 241), which allows pharmacists to provide drug cost information to patients, along with HB 436, which prohibits limitations on disclosures of such information. In addition, Governor John Bel Edwards signed SB 283, which requires pharmaceutical benefit managers to issue an annual transparency report about how they operate in the state.

In 2017, legislature focused on regulating healthcare price transparency by passing legislation that allows health insurance providers to negotiate charges and fees associated with individual health policies.

 

LEGISLATION/REGULATION

Legislative Calendar

Louisiana’s most recent legislative session ran from 3/12/2018 – 6/5/2018.

 

Recent Legislative Developments

Healthcare Transparency

2018 SB 241 PHARMACIST COMMUNICATION WITH PATIENTS ACT: Pharmacists may provide sufficient information to a patient to allow him an opportunity to consider all relevant options when acquiring prescription medication, including but not limited to the cost and clinical efficacy of a more affordable alternative if one is available and the ability to pay cash if a cash payment for the same drug is less than an insurance copayment or deductible payment amount. Passed – Signed by Governor on 5/18/18 and became Act No. 317 (reenacts R.S. § 22:1657; enacts R.S. 37:1219).
HB 734 REQUIRES REPORTING OF DATA ON HEALTHCARE PROVIDER CLAIMS SUBMITTED TO MEDICAID MANAGED CARE ORGANIZATIONS: Requires that the report produce data on healthcare provider claims delineated by individual Medicaid managed care organization and separated by provider type including, but not limited to: the total number and dollar amount of claims for which there was at least one denied claim line; the total number and dollar amount of completely denied claims; the total number and dollar amount of claims adjudicated in the reporting period; total number and dollar amount of denied claims divided by the total number and dollar amount of claims adjudicated; and total number and dollar amount of adjusted claims. Passed – Sign by Governor on 6/1/18 (R.S. § 46:460.91.)
HB 436 PROVIDES RELATIVE TO THE REGULATION OF PHARMACY BENEFIT MANAGERS: Prohibits limitations on disclosures by pharmacists regarding drug costs and requires certain actions by pharmacy benefit managers after a successful appeal of a maximum allowable cost for a specific drug. Passed – Signed by Governor on 5/31/18 (Act No. 597)
SB 283 PHARMACY BENEFIT MANAGERS: requires pharmacy benefit managers to issue an annual transparency report that discloses aggregate data on rebates received from drug manufacturers, administrative fees, and aggregate rebates received that did not pass through to the health benefit plan or insurer. Passed – Signed by Governor on 5/20/18 and became Act No. 371 (amends and reenacts R.S. § 22:1657 & R.S. 44:4.1(B)(11); enacts R.S. 22:1657.1).
HB 547 PROHIBITS PENALTIES FOR DISCLOSURE BY PHARMACISTS OF CERTAIN PRESCRIPTION DRUG COST INFORMATION: Bans the practice known informally as the “gag rule on pharmacists” by prohibiting penalties on pharmacists for disclosure of certain information on the cost of prescription drugs. Inactive/Dead.
2017 SB 59 PHARMACEUTICAL PRICING & PAYMENT: The Louisiana Board of Pharmacy shall develop a website to contain prescription drug price information to be made available to Louisiana prescribers on the board’s website with a dedicated link that is prominently displayed on the board’s home page, or by a separate easily identifiable internet address. Passed – Signed by Governor on 6/14/17 (R.S. § 37:1251)
2015 HB 498

 

PUBLIC INFORMATION CONCERNING PRICES AND QUALITY OF HEALTH SERVICES: requires the Department of Health and Hospitals to identify healthcare cost, quality, and performance data elements that would be meaningful in facilitating consumer comparisons of healthcare services and create the online process by which providers and health plans can provide the data. Reported information will include: (i) data identifying at least 15 of the most commonly used procedure codes and (ii) any emerging health trends for diagnosis and treatment related to hospitalization. It will also include a list of hospitals and other licensed health facilities that are in compliance with reporting requirements, as well as the hospitals not in compliance. The Department is required to update these databases on an annual basis. Passed—Signed by the Governor on 6/29/15 (Act No. 338).

 

Healthcare Cost

2018 HB 243 DRUGS/PRESCRIPTION: Prohibits a manufacturer or wholesale distributor of an essential off-patent or generic drug from engaging in price gouging in the sale of the drug. Authorizes the secretary of the La. Dept. of Health to notify the attorney general of any increase in the price of an essential off-patent or generic drug if the price increase, by itself or in combination with other price increases, would result in an increase of 50% or more in the wholesale acquisition cost of the drug or the price paid by the medical assistance program for the drug within the preceding one-year period and a 30-day supply of the maximum recommended dosage of the drug for any indication or a full course of treatment with the drug, according to the label for the drug approved under the federal Food, Drug, and Cosmetic Act, would cost more than $80 at the drug’s wholesale acquisition cost. Inactive/Dead.
HB 280 PREMIUM PAYMENT REQUIREMENTS IN THE MEDICAID PROGRAM: Establishes a premium payment requirement in the La. Medicaid program and makes Medicaid eligibility for certain enrollees contingent upon payment of premiums. Provides that if a Medicaid enrollee with income between 100% and 138% of the federal poverty level who is deemed not to be medically frail does not make his required premium payment for a period of 60 days or more, the department shall terminate his Medicaid eligibility. Inactive/Dead.
SB 282 PROVIDES RELATIVE TO PRESCRIPTION DRUG PRICING: Requires certain health insurance issuers to notify enrollees that they are subject to an excess consumer cost burden when they are charged more for a prescription drug than their insurer pays or would pay after considering drug rebates from the drug manufacturer into the total cost of the drug. Requires certain health insurance issuers to certify to the commissioner of insurance that they passed on to the consumer at least 50% of the rebates received from drug manufacturers. Passed – Signed by Governor on 5/31/18 (Act No. 579).
HR 208 REQUESTS THE DEPARTMENT OF INSURANCE TO ESTABLISH A TASK FORCE TO MAKE RECOMMENDATIONS FOR PROPOSED LEGISLATION TO ADDRESS THE ISSUE OF BALANCE BILLING IN LOUISIANA: Urges and requests the Dept. of Insurance to establish a task force to research and make recommendations for proposed legislation and policy changes to address the issue of balance billing. Passed – Taken by Clerk of the House and presented to the Secretary of State on 5/18/18.
HB 710 PROHIBITS A MANUFACTURER OR WHOLESALE DISTRIBUTOR FROM ENGAGING IN UNRESTRAINED PRICE INCREASES IN THE SALE OF AN ESSENTIAL OFF-PATENT OR GENERIC DRUG: authorizes the secretary of the La. Dept. Of Health to notify the attorney general of any increase in the price of an essential off-patent or generic drug if the price increase, by itself or in combination with other price increases, would result in an increase of 50% or more in the wholesale acquisition cost of the drug or the price paid by the medical assistance program for the drug within the preceding one-year period and a 30-day supply of the maximum recommended dosage of the drug for any indication or a full course of treatment with the drug, according to the label for the drug approved under the FDA would cost more than $80 at the drug’s wholesale acquisition cost. Inactive/Dead.
HB 556 PROVIDES RELATIVE TO OUT-OF-NETWORK BALANCE BILLING: Provides for a reimbursement rate for out-of-network claims and requires health insurers to establish a mediation process for the settlement of claims. Inactive/Dead.
SB 226 MAXIMUM ALLOWABLE DRUG PRICING IN THE MEDICAID PHARMACY PROGRAM: Requires a pharmaceutical drug manufacturer to remit a combination of federal and state supplemental rebates in an amount that will make the net cost of the drug no more than is available to other enumerated entities in order for the drug to be included on the Medicaid preferred drug list. Inactive/Dead.
2017 HB 407 PRODUCER FEES FOR INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES: Allows health insurance producers to negotiate charges, fees, and any other form of compensation directly with the insured for an individual health and accident policy. Passed – Signed by Governor on 6/3/17 and became Act No. 63 (amends and reenacts R.S. § 22:855(B)(1) and (2)(c) and 1568(B); enacts R.S. § 22:855(B)(2)(d)).


Healthcare Markets

2018 SB 517 PROVIDES RELATIVE TO QUALIFIED HEALTH PLAN PRESCRIPTION DRUG COVERAGE: Requires health insurance issuers who offer qualified health plans to offer at least one plan in each metal tier that does not require an enrollee to pay a prescription drug deductible or pay more in co-pay or co-insurance than the amount specified in the summary of benefits posted on the health insurance issuer’s website. Inactive/Dead.
HB 472 LOUISIANA HEALTH REINSURANCE ASSOCIATION: provides for stabilization of the individual health insurance market, an association of health insurance issuers, health maintenance organizations, group self-insurers, and third-party administrators is hereby created. Members of the association are subject to a fee assessment promulgated by the commissioner to provide for a state-based reinsurance fund to stabilize the individual health insurance market. Inactive/Dead.
HB 339 PROVIDES RELATIVE TO THE PRACTICE OF TELEMEDICINE: Provides that a physician who lawfully practices telemedicine in La. shall not be subject to any regulatory prohibition or restriction on the practice of telemedicine in all instances. Inactive – Withdrawn from House.
HB 384 STATE PRESCRIPTION AND DRUG IMPORTATION PROGRAM: Requires the La. Department of Health to develop and submit for federal approval a program for importing prescription drugs from Canada. Inactive/Dead.
SB 130 PROVIDES RELATIVE TO CONTRACTS FOR MEDICAID PHARMACY BENEFIT MANAGEMENT SERVICES: requires Medicaid pharmacy benefit manager contracts to be limited to a set per transaction rate for every pharmacy claim paid. Passed – Signed by Governor 5/25/18 (Act No. 483).

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Rev. Stat. Ann. § 40:1253.2 directs the Department of Health and Hospitals to submit an annual report respecting the Louisiana Medicaid Bayou Health program to the Senate and House committees on health and welfare in order to monitor the transition from fee-for-service based programs into managed care organized based programs. The report must contain, among other things, the number of members who chose the coordinated care network and the number who are auto-enrolled, including the amount the total payments and average per member per month payment paid to each coordinated care network. The report also must contain a number of performance metrics, utilization data, and financial statements.

 

  • Rev. Stat. Ann. § 40:1173.1 articulates the legislature’s findings that as a result of rising health care costs and a shortage of providers in the state, “there is a need to have access to provider specific health care cost, quality, and outcome data on health care facilities, health care providers, and health plans as well as continued access to global patterns and trends in the availability, use, and charges for health care services and the associated health circumstances.”

 

  • Rev. Stat. Ann. § 40:1173.3, as part of the “Louisiana Consumer’s Right to Know Act,” directs the Department of Health and Hospitals to identify the health care cost, quality, and performance data elements to be reported to the department for facilitating “meaningful comparison” by consumers of costs for specific health care services among facilities, providers, and plans. Pending the availability of funds, the Department shall provide for online publication of provider and health plan specific cost, quality, and performance data for consumer use. The website has been implemented as healthfinderla.gov.

 

  • Stat. Ann. § 22:1657 prohibits pharmacy benefit managers from imposing “gag orders” by contract on pharmacies or pharmacists which prevent them from informing the patient of cheaper alternatives when filling their prescription drug.

 

  • Stat. Ann. § 37:1219 authorizes pharmacists to inform patients that cheaper alternatives may be available, including cash payment if it is cheaper than the patient’s insurance copayment or deductible amount.

 

  • Stat. Ann. § 46:460:91 requires the Louisiana Department of Health to produce and submit a report concerning the Medicaid managed care program and to conduct an independent review of claims submitted by healthcare providers to Medicaid managed care organizations.

 

  • Stat. Ann. § 37:1251 requires the Louisiana Board of Pharmacy to develop a website to contain prescription drug information to be made available to prescribers on the board’s website. Additionally, a pharmaceutical marketer must disclose any prescription drug marketing directed to a prescriber, his designee, or any member of his staff.

 

  • HB 436 prohibits pharmacy benefit managers, insurers, or other entities that administer prescription drug benefits programs from prohibiting by contract a pharmacy or pharmacist from informing a patient of all relevant options including the cost and clinical efficacy of a more affordable alternative if one is available and the ability to pay cash if a cash price for the same drug is less than an insurance copayment or deductible payment amount.

 

Healthcare Contracting

  • Rev. Stat. Ann. § 22:263 regulates contracts between a health maintenance organization (HMO) and a provider of healthcare services, stating that an HMO is prohibited from inducing a provider to reduce, limit, delay or deny medically necessary and appropriate services through any form of incentive.

 

Healthcare Costs

  • Act No. 579 requires certain health insurance issuers to notify enrollees and prospective enrollees that they may be subject to an excess consumer cost burden, requires some health insurance issuers to make available information regarding the value of rebates, and prohibits a health insurance issuer from publishing or otherwise revealing information regarding the actual amount of rebates the health insurance issuer receives.

 

  • R. No. 208 requests the Department of Insurance to establish the Balance Billing Policy Assessment Task Force to research and make recommendations for proposed legislation and policy changes to address the issue of balance billing in Louisiana.

 

Healthcare Markets

  • Rev. Stat. Ann. § 40:2116 prohibits specific provider-types (abortion facilities, adult day health care, adult residential care providers, nursing homes, home and community based service providers, hospices and pediatric day health care) from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Hospitals through the state’s Facility Need Review process. A facility need review – similar to a Certificate of Need in other states – aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

 

  • Rev. Stat. Ann. § 22:971 directs the Department of Insurance to provide for a patient bill of rights that guarantees patients to greater access to information and care, to expand choice, and to hold HMOs responsible for decisions that harm patients. In creating the bill of rights, the department shall establish and maintain an information collection program to track and evaluate state and federal efforts to provide for a uniform patient bill of rights, and shall submit an annual report to the legislature on recommendations to enact a uniform bill.

 

  • Stat. Ann. § 39:1648 requires Medicaid pharmacy benefit manager contracts to be limited to a set per transaction rate for every pharmacy claim paid and prohibits pharmacy benefit managers from retaining federal drug rebates, credits, or “spread pricing” amounts in excess of what they paid the pharmacist.

 

FY 2018 BUDGET

Louisiana’s fiscal year begins on July 1 and ends on June 30 the following year. Louisiana enacted its FY 2018 Budget during the special legislative session. To view Louisiana’s FY 2018 Budget, click here.

 

LITIGATION/ENFORCEMENT

  • None identified.

 

KEY RESOURCES

Louisiana State Legislature

Louisiana Office of the Attorney General