LA| The Notice, initiated on March 14, 2025, and published on April 20, 2025 in the Louisiana Register, Vol. 51, No. 4, details the Louisiana Department of Insurance’s Notice of Intent to promulgate Regulation 133, which establishes minimum standards for the adequate payment of pharmacy and pharmacist claims, ensuring reimbursements are at least equal to the acquisition cost for covered drugs, devices, or services. The regulation, mandated by Act 768 of the 2024 Regular Session, applies to all pharmacy benefit managers (PBMs) operating in Louisiana (with certain exceptions such as ERISA plans), and includes requirements for reimbursement formula benchmarks, a defined appeals process for claim payment errors, and compliance options for PBMs. The fiscal and economic impact statement anticipates no significant cost or revenue impact to state or local governments, with the regulation expected to be cost-neutral for the industry but beneficial to pharmacies and pharmacists by providing clearer reimbursement standards and reducing administrative burdens.
Key points:
- Regulation 133 requires PBMs to reimburse pharmacies and pharmacists at no less than the acquisition cost for covered drugs, devices, or services, and sets minimum payment system design standards.
- The rule mandates a transparent appeals process for pharmacies to challenge underpayments, and provides PBMs with compliance options, including benchmark-based reimbursement formulas and invoice-based payment systems.
- The regulation is expected to have no significant fiscal impact on government or small businesses, and aims to ensure compliance with legislative intent while offering modest administrative savings for the industry.
Click here to see LA DOI Notice of Intent to Promulgate Regulation 133