Overview
Louisiana has been active in legislative efforts to promote price transparency in health care. In recent terms, the state legislature introduced bills to tackle surprise billing by out-of-network specialists, proposing that patients should only be responsible for deductibles and copayment amounts that they would under the in-network terms of their insurance plans. The legislature is also taking steps to increase price transparency with a law aimed to reward people who shop for care. The proposed “Right to Shop Act” promotes higher value care by requiring insurance companies to offer incentive programs to enrollees for shopping for healthcare services at lower costs.
To address rising prescription drug prices, several Louisiana laws promote pharmaceutical price transparency. For example, the Louisiana Board of Pharmacy is required to post on a website prescription drug price information with a dedicated link prominently displayed on the board’s home page. Another law requires manufacturers engaging in marketing of prescription drugs in the state to report quarterly to the Louisiana Board of Pharmacy the current wholesale acquisition costs (WAC) for those drugs. The state also took various approaches to curb prescription drug costs by placing greater oversight over pharmacy benefit managers (PBMs). Enacted in 2018, the Pharmacist Communication with Patients Act prohibits PBMs from using “pharmacy gag clauses” that prevent pharmacists from telling consumers when there are cheaper prescription drug alternatives available. Additionally, state law prohibits PBMs from retaining “spread pricing” amounts in excess of what they paid the pharmacist. Under this law, Medicaid PBM contracts must be limited to a set per transaction rate for every pharmacy claim paid. It also establishes an “any willing provider” clause to prohibit Medicaid managed care organizations or PBMs from denying Louisiana licensed pharmacies and pharmacists from the opportunity to participate in the plan provider networks. To add another layer of transparency, PBMs are required to disclose in an annual report the percentage of any rebates received from drug manufacturers for formulary drugs.
In the provider market, Louisiana law requires prior notice of mergers and acquisitions of nonprofit hospitals to the state attorney general. The AG must review the proposed transaction based on criteria of affordable access to care to approve, approve with conditions, or disapprove. To disapprove the proposed merger, however, the AG must go to court to challenge and enjoin the transaction. The state additionally prohibits non-compete provisions in contracts that restrict the practice of any lawful profession, trade, or business for up to two years from termination of employment. The legislature is also considering a bill that would prohibit restrictive covenants for primary care physicians, regardless of employer, or any physician employed by the state from the practice of medicine.
See below for an overview of existing Louisiana state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 4/12/2021 - 6/10/2021 (2020-2021 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 119 – Louisiana
Introduced: 2019 Status: Enacted
Provides relative to the denial of a prescription based upon step therapy or fail first protocols or nonformulary status
HB 204 – Louisiana
Introduced: 2019 Status: Enacted
Provides relative to Medicaid provider fees assessed on nonpublic providers of emergency ground ambulance services. Existing law authorizes the La. Department of Health (LDH) to impose fees for the provision of Medicaid-funded healthcare services, commonly …
HB 211 – Louisiana
Introduced: 2019 Status: Enacted
Provides relative to Medicaid coverage of certain behavioral health services. New law limits individual behavioral health services providers rendering CPST services, PSR services, or both to a maximum combined total of 12 reimbursable hours of …
HB 237 – Louisiana
Introduced: 2019 Status: Inactive / Dead
Prohibits preexisting condition exclusions or other discrimination based on health status.
HB 243 (see similar bill HB 710) – Louisiana
Introduced: 2018 Status: Inactive / Dead
PROHIBITS A MANUFACTURER OR WHOLESALE DISTRIBUTOR FROM ENGAGING IN PRICE GOUGING 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 …
La. Rev. Stat. Ann. §§ 22:1121 through 22:1130: Healthcare Coverage for Louisiana Families Protection Act – Louisiana
Introduced: Status: Enacted
Statutes include provisions that become effective ninety days after the Patient Protection and Affordable Care Act is found unconstitutional. The Act includes statutes regulating rate setting, pre-existing condition exclusions, and limits on co-pays and deductibles.
Download
La. Rev. Stat. Ann. §§ 22:1131 through 22:1138: Louisiana Guaranteed Benefits Pool Act – Louisiana
Introduced: Status: Enacted
Statutes order the commissioner to establish the Louisiana Guaranteed Benefits Pool which shall be a risk-sharing program to provide payment to health insurance issuers for healthcare services provided to eligible individuals with expected high healthcare …
Download
La. Rev. Stat. Ann. §§ 22:1201 through 22:1214: Louisiana Health Plan Act – Louisiana
Introduced: Status: Enacted
Statutes explain the purpose of the Louisiana Health Plan, including that it was created to provide health care coverage to those with preexisting conditions. Statutes state that any pricing information contained in any contract made …
Download
La. Rev. Stat. Ann. §§ 22:1241 through 22:1252: Louisiana Safety Net Health Insurance Program – Louisiana
Introduced: Status: Enacted
The Louisiana Safety Net Health Insurance Program shall provide for minimal benefit hospital and medical policies. Participating health insurance issuers shall offer minimal benefit hospital and medical insurance policies that allow enrollees to access at …
Download
La. Rev. Stat. Ann. §§ 22:1260.1 through 22:1260.11: The Louisiana Discount Medical Plan Act – Louisiana
Introduced: Status: Enacted
The purpose of this Subpart shall be to protect the public from inappropriate, unfair, and deceptive marketing, sales or enrollment practices and to facilitate consumer understanding of the role and function of discount medical plan …
Download
In re Matter of LCMC Health & HCA Healthcare – Louisiana
District Court: Eastern District of Louisiana Status: Decided
This action arises out of the FTC’s objection to LCMC’s acquisition of three hospitals owned by HCA Healthcare in Louisiana. LCMC, a nonprofit hospital that …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
In re: Flonase Antitrust Litigation – Louisiana, Pennsylvania
District Court: Eastern District of Pennsylvania Status: Pending
On December 22, 2017, the U.S. Court of Appeals for the Third Circuit ruled that an antitrust suit filed by Louisiana’s Attorney General against GlaxoSmithKline …
Additional Resources
STATE BUDGET
Louisiana’s fiscal year begins on July 1 and ends on June 30 the following year. To view Louisiana’s state budget from the Office of Planning and Budget, click here.
KEY RESOURCES