The Senate Pharmacy Benefit Manager Monitoring Advisory Council convened on September 22, 2025, to discuss the implementation and enforcement of Act 474, a significant piece of legislation aimed at reforming pharmacy benefit manager (PBM) practices in Louisiana. The act addresses several controversial practices, including spread pricing and patient steering, and aims to enhance transparency in the PBM industry.

The meeting began with a summary of Act 474, which prohibits spread pricing effective January 1, 2027, allowing PBMs and health plans time to renegotiate contracts. The act also introduces new definitions, including those for local pharmacies and specialty drugs, and establishes a framework for fair reimbursement practices. Notably, it mandates that PBMs must pass through all rebates and price concessions to health plans, which must then be shared with plan members.

Key provisions of the act include a prohibition on patient steering, which prevents PBMs from influencing patients to use preferred pharmacies, and a requirement for PBMs to notify pharmacists of claim payment errors, ensuring retroactive adjustments are made. The act also enhances the authority of the commissioner of insurance to review PBM compensation programs, increasing access to data regarding PBM revenue generation.

During the meeting, Mr. Opelka presented on the enforcement and monitoring of PBMs, outlining the changes to Title 22, specifically regarding spread pricing and effective rate pricing. The council discussed the importance of monitoring complaints and market conduct to ensure compliance with the new regulations. Effective rate pricing, which prohibits certain fees between PBMs and local pharmacies, is already in effect and will be enforced through complaints from pharmacies.

The council emphasized the need for ongoing data collection and updates to ensure that the goals of Act 474 are met, particularly in increasing transparency and ensuring affordable access to prescription medications for Louisiana citizens. The meeting concluded with a commitment to continue monitoring PBM practices and to explore further legislative measures as necessary.