House committee advances Turner PBM bill to set per-prescription fees and boost transparency

Representative Jim Turner, the sponsor of House Bill 938, told the House Insurance Committee on April 1 that the bill aims to make pharmacy benefit manager (PBM) arrangements more transparent and to level reimbursement across pharmacies.

"This bill lets the PBMs charge per script an amount that they think they can run their business by," Turner said, describing a set per-prescription administration fee and a dispensing fee tied to Medicaid rates. Turner said reimbursements would be pegged to NADAC, the national average drug acquisition cost, and that the Louisiana Department of Insurance would gain enforcement authority to recover improperly retained rebates or spread-pricing funds.

Turner also described a procurement change he called a "reverse auction" for the Office of Group Benefits (OGB). Under that procurement model, bidders submit fees publicly and competing offers reduce the winning price over several rounds, he said, with the stated goal of increasing competition and reducing costs.

The bill would also limit PBM compensation in certain circumstances to a flat service fee and require 100% rebate pass-through to plans, with exceptions and performance-based provisions described by the sponsor.

Opponents, including labor trustees and industry representatives, said the changes could raise costs for plan participants or be preempted by federal law. Joshua Sonnier of Ironworkers Local 623 said the dispensing fee would be passed through to plan participants and trustees would struggle to absorb a sudden cost increase. "The dispensing fee ... gets passed on to us, the plan participants," Sonnier testified.

Phil Cristofanelli of the Pharmaceutical Care Management Association (PCMA) told the committee that statewide mandates to "delink" PBM pay from savings and to require flat fees have not been tried broadly and, in his view, risk higher drug prices and premiums. "It will result in higher drug prices," Cristofanelli said, arguing that PBMs currently align incentives to negotiate manufacturer discounts and that mandating a flat fee would reduce that incentive.

Christy Copeland, a benefits consultant for NABIP Louisiana, presented an employer-level analysis using a client's 2025 claims, saying enforcement of the bill as written would have increased costs by 23% and raised members' co-pays. "The increase in cost would have been 23%," Copeland said, and she urged the committee to review employer-level impacts.

Representative Jordan and other members raised legal questions, citing the PCMA v. Moretti line of cases and ERISA preemption concerns. Jordan warned that provisions that "restructure how plans are administered" could be vulnerable in federal court and urged the sponsor to reexamine parts of the draft.

Turner said he has worked with stakeholders and counsel and acknowledged continued drafting was likely; he also pointed to both past state reforms and recent federal changes as context. After discussion and the adoption of an amendment set (1444) that adjusts effective dates and adds a conflict-of-interest bar for procurement consultants, the committee reported HB 938 with amendments by unanimous voice action with no objection.

The committee record shows the sponsor committed to continued stakeholder negotiations on drafting details, including language around commissioner access to PBM claims and enrollment data and terms defining "substantial" covered lives that would trigger disclosure requirements.

What happens next: HB 938 was reported with amendments and will move to the full House for further consideration; the sponsor and stakeholders said they will continue to refine legal and technical language.