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Senate passes comprehensive PBM overhaul aimed at lowering drug costs and increasing transparency
Summary
Lawmakers passed House Bill 264 to constrain spread pricing by pharmacy benefit managers (PBMs), require more transparent reporting to the insurance commissioner, set reimbursement standards to support local pharmacies, and require pass-through of rebates to plans and plan members beginning in 2027.
The Louisiana Senate passed House Bill 264 after floor debate and a series of amendments that sponsors said will rein in pharmacy benefit managers (PBMs), increase transparency and help independent local pharmacies.
Senator Regina Bass, presenting the bill on the floor, summarized a broad set of changes: the legislation updates definitions, prohibits spread pricing without carve-outs, establishes a NADAC-plus reimbursement and an appeals mechanism to support local pharmacies, and requires more detailed PBM reporting to the state insurance commissioner. Senator Bass said the bill also removes prior exemptions that permitted PBMs to opt out of patient‑steering prohibitions and delays the spread-pricing prohibition until Jan. 1, 2027 to allow renegotiations between plans and PBMs.
Other provisions adopted on the floor require PBMs to notify pharmacists of claims-payment errors and make retroactive adjustments, require PBMs beginning January 2027 to pass through rebates and price concessions to health plans and for plans to reflect shared savings in plan design, and empower the insurance commissioner to review PBM compensation programs and pursue enforcement actions.
Supporters argued the changes will force PBMs to accept lower internal margins and direct more savings to plan members; Senator Bass said, "This is Louisiana saying to the PBMs, we expect you to take less for yourself and provide consumers with the things that lower premiums and lower co pays." The Senate adopted the amended bill and recorded final passage with a 38-0 tally in the transcript.
Why it matters: The measure changes how PBMs operate and report in Louisiana, affects reimbursement and payment practices that determine pharmacy viability and patient costs, and establishes a regulator enforcement framework.
What happens next: With Senate final passage recorded, the law (as enacted) will require the insurance commissioner and state agencies to implement the report formats and enforcement authorities and to oversee PBM compliance. Some provisions have delayed effective dates to allow contractual transitions.
Votes and action: Final passage of House Bill 264 recorded in the Senate transcript with a tally of 38 yeas and 0 nays; amendments to delay spread-pricing prohibition and require rebate pass-through were adopted on the floor.
