[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",5977773,"mediaKeyId","5808718-fda11fbc573f3762988a56c092bb30fb","parentId",5808718,"title","Louisiana health department returns pharmacy management to Medicaid managed-care plans, citing policy misalignment","audioSeconds",257,"startMs",4796000,"endMs",5053000,"viewUrl","/Search/View?dp=1&key=5808718-fda11fbc573f3762988a56c092bb30fb&start=4796&end=5053","thumbnailUrl","https://assets.pipeline.soar.com/5808718-fda11fbc573f3762988a56c092bb30fb/thumbnail_4796000.jpg","articleUrl","/articles/5977773/Louisiana/Louisiana-health-department-returns-pharmacy-management-to-Medicaid-managed-care-plans-citing-policy-misalignment","mediaUrl","https://secure.pipeline.soar.com/5977773-2c6c8c738052b1b7cb7fe2f06166a5b8/orig.mp4?Expires=1770796682&Signature=PWL2E36Cs5ttsML0-b~2q0y-qmPSvnE1MjXB8VmIkBVYf97Gagvwvvbuv4MWm8pW2DQinZvbCZ03jzJKlRz1PWarOL3~tF3CfQpvlg2mUqxD0Ep7OwbZYI7hSNXHNi-hurC-SMc7kxJTIj13HfgDoUZIwuOpNkmmGOsi~-o6j8UO1oaGQpuYLKHsVdcYQxRmLwFzDm5FG1JsKmcZmsroxWFqvY4lj06xREb0Ws4RTyJ8HB2HTwJYxdPq1rhObHtNPlnPNT3aD~cT~r-zYssvWZjDZZQfwlKmp7wDKgVGZG5Ei1ZFenLJKeO69zpcs4QoC5PodoGvGIK0hGFjgM8Qdg__&Key-Pair-Id=KUT5TJCACFTXG","author","Louisiana Legislature","date","2025-09-22T00:00:00Z","article","The Louisiana Department of Health announced the state will transition pharmacy management for Medicaid away from a single PBM back to the six Medicaid managed-care organizations, with a go-live date of Oct. 1, under testimony by LDH undersecretary Drew Maranto during the advisory council meeting on Sept. 22.

Maranto, identified in his testimony as undersecretary and interim Medicaid director, said the department decided to reverse the single-PBM approach after concluding that the original contract and implementation did not place the department in a strong operational position. \"As of April, the department made a decision to transition away from the single PBM that we were currently using and send that function back to the 6 managed care plans,\" Maranto said. \"I am happy to report there has been a tremendous amount of work to get this done, in just a few months. And so that go live is October 1.\"

Maranto said the single-PBM contract began Oct. 28, 2023, under a prior procurement and that the department found misalignment between the PBM contract terms and the state's goals for member outcomes and cost management. He and Department of Health Secretary Bruce Greenstein both described structural problems: Greenstein said the contract \"held no risk to the cost, but the plans maintained the risk,\" and that the imbalance contributed to rapidly rising drug spending during fiscal 2025.

Maranto said the department's immediate priority was to execute the transition without disrupting pharmacy access for members and to make sure members receive new cards and understand plan changes. He said the department will continue work on longer-term managed-care contracting decisions as the current managed-care contracts approach expiration.

Ending: LDH asked for cooperation from managed-care plans and other stakeholders during the near-term transition and said the department will outline next steps for managed-care procurement and pharmacy benefit design in coming weeks.","mediaType","Video","parentTitle","Senate Pharmacy Benefit Manager Monitoring Advisory Council Sep 22, 2025","oneSentenceSummary","The Louisiana Department of Health said on Sept. 22 it will transition pharmacy management back to six managed-care organizations effective Oct. 1 after concluding the single-PBM contract did not align with departmental goals for member care and program cost control.","taxTitle","2025 Legislature LA, Louisiana","taxId",78558,"location","Louisiana","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},5977778,"LDI to audit PBM transparency filings after Southern Scripts rebate report spikes",3376,1349000,4725000,"/Search/View?dp=1&key=5808718-fda11fbc573f3762988a56c092bb30fb&start=1349&end=4725","https://assets.pipeline.soar.com/5808718-fda11fbc573f3762988a56c092bb30fb/thumbnail_1349000.jpg","/articles/5977778/Louisiana/LDI-to-audit-PBM-transparency-filings-after-Southern-Scripts-rebate-report-spikes","https://secure.pipeline.soar.com/5977778-059be2053f0576ec4f93d378609d52f4/orig.mp4?Expires=1770796682&Signature=Yi0rjRDQ7lnKpWpTa-P-EKR8W7Ouf7s8vzZoDnpHE7Uuy9D0fw7FLR5oYJilPeQGnHUjleA4jIAjhp5hVkrSFmgvpr~Bso2S4NnQlHset3ZcqwgfmnSft4WhgHtYDfLQRifOhx4yNhjhSaHacxICZ5TLkbLZwMYXbEzSA6ibWFLFdTY9WK-LTsc44wEKqBz-FlsBnWkgyDwd~gLcs436d1kK0-AlYdwGtKaDXX-u5nb6RcM~AVf5joQLvWM~-NwfJHQnMZdQT1JZJSThzOE8rP1gd~rQ3uiZJegHSIddBSZoAeWzyByPIJ64gTfYFqXFnlNtnW1EvW~mNz99v38uuQ__&Key-Pair-Id=KUT5TJCACFTXG","Department of Insurance staff and council members discussed anomalies in the PBM transparency reports and said the department will add audit functions as Act 474 takes effect.

Senator Jay L. Bass and others asked why some PBMs appear multiple times in the transparency database. LDI staff explained those multiple entries generally reflect separate plan-level filings (for example, separate fully insured and self-funded ERISA lines). The department said it will publish an Excel export of reported data and that plan-level detail will be added to the form-review process.

Senator McMath raised an apparent anomaly: two filings showed Southern Scripts' reported rebates climbing from about $8.6 million in one prior report to roughly $960 million in the most recent filing. LDI counsel said prior to Act 474 the agency aggregated reports and lacked enforcement authority tied to the filings; with the statute's new obligations the department will begin validating filings, perform look-back audits and escalate discrepancies.

\"Until this act, we essentially just received those reports, aggregated them, and posted them on the website,\" an LDI staff member said. \"There is going to be a look back.\" The department confirmed it will audit filings in March cycles and pursue market-conduct reviews if a pattern of inconsistent or implausible reporting emerges.

LDI said it will require PBMs to report totals at the plan level and will publish updated transparency files at LDI's website. The department asked committee members to forward specific PBM questions so staff can follow up with companies and, if necessary, bring PBM representatives to future meetings to explain reporting differences.

Ending: The department said it will circulate the full transparency dataset to council members, perform audit reviews of suspicious filings, and use discretion to escalate to enforcement if look-back audits show reporting errors or intentional misreporting.","Department of Insurance staff told the advisory council on Sept. 22 that plan-level transparency reporting will be audited and that prior reporting was aggregated; the department flagged an apparent year-over-year anomaly in Southern Scripts' rebate reporting and said a look-back audit is planned.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},5977783,"Cost Plus Drugs founder urges transparency, shows company's markup model to advisory council",779,1594000,2373000,"/Search/View?dp=1&key=5808718-fda11fbc573f3762988a56c092bb30fb&start=1594&end=2373","https://assets.pipeline.soar.com/5808718-fda11fbc573f3762988a56c092bb30fb/thumbnail_1594000.jpg","/articles/5977783/Louisiana/Cost-Plus-Drugs-founder-urges-transparency-shows-companys-markup-model-to-advisory-council","https://secure.pipeline.soar.com/5977783-85e04d7ed9e39fd5f64ff9bd7f868b0a/orig.mp4?Expires=1770796682&Signature=gdx7hR6FcPT4hZQRy-0UVysBdaV2EQi86r5O3-5fkhjx8jmFJWEj5Q4hU3hb24JYBOZXXRpNfmfiAEU~s2i3cYs0tWNkfHMz2s5paaMdcrrT4C1m4-RhHl-kEG4q1IZGUZ5FL79jMwjJAUkapuCmy0BZCrqxMkjQehQhsR4OW6jM8OHQtkAmihtoxd2DvP4UFBKpUfyGxZeFxYHcSJtlMIADk~kXJRDxA2EDGV4zAQ0YDPwg54EScPRxg8603kzVsAxWe6B1zleym~M6DyjyhUR-p~-CpgtcoC9L0Pj3PFnOkJz5wWlU6QOfqsj4VD8zW~OZN9g2kaAy3FTnw4mMlQ__&Key-Pair-Id=KUT5TJCACFTXG","Alexander Oshmyansky, founder of Cost Plus Drugs, told the Pharmacy Benefit Manager Monitoring Advisory Council on Sept. 22 that his company's model of publishing acquisition costs and charging a flat markup reduces prices dramatically for many generic and specialty drugs and offers a private-sector example of transparency.

\"We reveal the cost that we purchase the drugs at,\" Oshmyansky said. He described Cost Plus Drugs' public price pages, a flat 15% markup on ingredient cost, a $5 pharmacist fee for mail-order and higher dispensing fees for retail pickup through the company's retail network. \"You can go right now, costplusdrugs.com, and you will see for every single drug exactly what we paid for it,\" he said.

Oshmyansky told the council his firm's model sometimes produces steep reductions versus conventional market prices: he said some medicines that patients were paying thousands of dollars for through conventional channels are available through Cost Plus Drugs for tens of dollars. He said his company also operates a wholesale marketplace, a retail network called the Team Cuban card, a mail-order pharmacy and a manufacturing facility in Texas that produces sterile injectables.

Oshmyansky described how PBM practices, vertical consolidation and the use of offshore group purchasing organizations can obscure real net prices and produce large markups. \"Moving on to vertical integration with these group purchasing organizations, and now they're actually starting their own pharmaceutical companies,\" he said, calling some of the industry structures \"a shell game\" that shifts money through multiple affiliates and fees.

He told the council the company works with smaller transparent PBMs and sells into employer and institutional channels through partners, but that large branded manufacturers remain difficult to engage because manufacturers fear losing formulary access if they depart from longstanding rebate-driven arrangements.

Council members asked about Cost Plus Drugs' pricing mechanics and partnerships. Oshmyansky said the Team Cuban card network includes roughly 20,000 participating pharmacies; retail prices use acquisition cost plus a $12 dispensing fee ($16 for cold-chain products) plus the 15% ingredient markup. He said the company is considering passing through actual shipping costs for mail order in the coming year.

Ending: Oshmyansky praised Louisiana's Act 474 reforms and urged regulators to watch for new fee structures and offshoring of services; he urged the state to require transparency of downstream service fees and group purchasing organizations to prevent new forms of opaque charges.","Alexander Oshmyansky, co-founder of Cost Plus Drugs, told the PBM monitoring council on Sept. 22 that his company posts acquisition costs and uses a flat 15% markup plus modest dispensing and shipping fees, and urged Louisiana to press for broader transparency to curb PBM-driven price inflation.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},5977788,"Louisiana insurance regulator outlines enforcement plan to implement Act 474 targeting PBM practices",1013,274000,1287000,"/Search/View?dp=1&key=5808718-fda11fbc573f3762988a56c092bb30fb&start=274&end=1287","https://assets.pipeline.soar.com/5808718-fda11fbc573f3762988a56c092bb30fb/thumbnail_274000.jpg","/articles/5977788/Louisiana/Louisiana-insurance-regulator-outlines-enforcement-plan-to-implement-Act-474-targeting-PBM-practices","https://secure.pipeline.soar.com/5977788-bbe2fa05f44e995f4e34493d2a0693c4/orig.mp4?Expires=1770796682&Signature=YCPSbPLVdsW3OAfzCjs~rTitNXcd1qkfPxFk-w2glgaf-LRzgC5P~OCf8WHbOXMH-lR3x37ldFUUIN~DpPf8RbeFfPEaVjxEPG87d0H6-sewSIzYkBXKHz6MFJ-zv1SDydP15~P8oHWLE63IOuNf9bG9r2Z8SaFohj-M-jHbCVZIxNa2-5sXvm00dTpAYE-GJgL15rQnCX2qSkLVDIz6TdV3y80jR~n1lPmGFwb9isrFiN5oLgn1BAwBvO5ZkBy4fjAwMSsBVGqX3~Aiccg6~eRTLehPw7He4c5IcWRcfOkSYCuVg5SybsFmT~xMe7mDsYUzcgRsuMGyHwDJ6sEfCg__&Key-Pair-Id=KUT5TJCACFTXG","The Louisiana Department of Insurance outlined how it will enforce Act 474 and implement new pharmacy benefit manager (PBM) rules during the Pharmacy Benefit Manager Monitoring Advisory Council meeting on Sept. 22 in the Henkel Room. Deputy Commissioner Frank Opelka described the department's complaint-driven enforcement approach, new reporting requirements and the timetable for several provisions.

Opelka said the statute deletes prior exceptions and makes spread pricing \"blanket prohibited throughout the state.\" He told the council the department will rely largely on complaints and market-conduct investigations rather than prospective contract reviews to detect violations. \"Implementation of that is essentially through complaints or notification of market conduct within the state,\" Opelka said.

The law requires PBMs to reimburse eligible local pharmacies at NADAC (the National Average Drug Acquisition Cost) plus a markup and a professional dispensing fee beginning in January; Opelka said the department is preparing guidance and expects the ingredient-side markup to land around 1.6%. He said the statute also requires PBMs to create an appeals process giving pharmacies 15 days from payment to request reprocessing if the paid amount does not cover acquisition cost, and that PBMs must notify pharmacies when a group of claims should be reprocessed.

Act 474 also prohibits so-called effective-rate clawbacks, DIR fees and other post-sale aggregate reductions by PBMs to local pharmacies and outlaws patient-steering tactics and certain uses of patient data. The law delays the requirement that rebate dollars be passed through to plan sponsors until Jan. 1, 2027 to allow plans and PBMs to renegotiate contracts; Opelka said the pass-through language will become part of the department's form-review process so approved plan forms explicitly disclose how rebates are allocated to sponsors and members.

Opelka said the law expands the commissioner's authority to audit PBM compensation programs and contracts with issuers and pharmacies. He estimated an initial contract cost of roughly $90,000 per PBM for in-depth compensation-program reviews and said the department will seek to shift available budget authority to cover as many reviews as it can. He described two enforcement tracks: an individual complaints process that can trigger claim-level fixes and a market-conduct escalation for widespread or systemic noncompliance.

The statute also tightens civil remedies and reporting. It classifies violations of the rebate pass-through requirement as unfair trade practices subject to fines; Opelka described the statutory penalty structure, including a $1,000-per-violation cap up to $100,000 for non-negligent violations and higher negligence/knowing-violation penalties (he said the department expects negligent-violation thresholds would be the more likely enforcement path, with fines up to $25,000 per violation and aggregate ceilings that could reach $500,000 per six months). PBMs must file an annual certification by their CEO or CFO attesting compliance with rebate pass-through requirements.

Opelka said the act requires significantly more granular transparency data than prior law: PBMs will report totals at the plan or issuer level (the department intends plan-level reporting), including total rebates received, total administrative fees, total price concessions, rebates passed through at point of sale, reimbursements disaggregated by local and nonlocal pharmacies, specialty-drug rebates, payments to PBM-owned affiliates and the PBM's vertical structure. The department will publish an aggregated transparency report 60 days after receiving filings and will open an audit function to validate filings.

Opelka told the council the department will issue guidance in the next month or two to define terms such as \"significant\" price increases for manufacturer WAC notification (the law requires manufacturers to notify the department within 30 days of specified WAC increases). He also said the department may pursue regulation for areas where the statute leaves interpretive questions, especially if marketplace confusion becomes apparent.

The council discussed the legal reach of the statute to cover PBM-related offshore entities and affiliated group-purchasing organizations; Opelka said the law is written to capture PBM activity from manufacturer to plan and that entities acting as PBMs in Louisiana should be licensed and subject to the statute, though enforcement would require detection and audit work.

Ending: The department said it will circulate guidance and the updated transparency-reporting template, set up a certification process for PBM executives, and begin auditing filings and complaints under the new law. Opelka said budget limits will constrain how many in-depth compensation-program exams the department can complete in the first year but that the agency will prioritize work to address high-risk or high-volume complaints.

","At a Sept. 22 advisory council meeting, the Louisiana Department of Insurance described how it will enforce Act 474\u0000\u0000\u0000including prohibitions on spread pricing, a NAADAC-plus reimbursement benchmark for local pharmacies, a required pharmacist appeals process and new plan-level rebate reporting.","actionData","errors"]

Article not found

Louisiana health department returns pharmacy management to Medicaid managed-care plans, citing policy misalignment

LDI to audit PBM transparency filings after Southern Scripts rebate report spikes

Cost Plus Drugs founder urges transparency, shows company's markup model to advisory council

Louisiana insurance regulator outlines enforcement plan to implement Act 474 targeting PBM practices