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Panel approves amendment to biosimilar coverage bill after debate over WAC vs. net cost reporting
Summary
The committee adopted amendments to House Bill 870 requiring insurers to report wholesale acquisition cost and a defined net cost per NDC and allowed regulators to accept net‑cost logic for formulary placement with written notice; the bill was reported favorably as amended.
House Bill 870, introduced in the House and presented in committee by Brett Mishlin of the Association for Accessible Medicines, would require insurers and PBMs to cover lower‑priced generics or biosimilars when they are available and to avoid using utilization management to block access to lower‑cost alternatives.
Mishlin told the committee the bill uses the wholesale acquisition cost (WAC) as a transparent, industry‑accepted number to compare prices and promote competition. "This bill really does two simple things… then that insurance company or the PBM should cover it at a lower cost to the patient," he said.
Insurers and employer representatives raised concerns that WAC is a list price not generally paid by purchasers; Malam Ford, vice president of pharmacy at Louisiana Blue, warned using WAC could force plans to add a first‑to‑market biosimilar that is priced higher on a net basis than the brand after rebates, then be locked into it by state formulary renewal rules. Josh Saunier (Louisiana AFL‑CIO) and others raised ERISA and plan‑design implications for self‑funded plans.
To respond, the committee considered and then adopted an amendment package (amendment set 3,229) that: defines "net cost" as WAC minus rebates, discounts and fees; requires an insurer that opts to use the net‑cost calculation for branded drugs to notify the commissioner in writing within 30 days; and requires per‑NDC reporting of WAC, net cost, and comparative cost‑sharing so regulators can verify whether net‑cost logic yields lower patient costs.
The author and proponents said the reporting requirement would provide the transparency many senators sought. LDI staff described the amendment as a "trust but verify" approach — allowing net‑cost logic but requiring written notification and line‑item reporting so regulators can compare WAC to net cost and guardrails can be added later if necessary.
After the amendment was offered and accepted without objection in committee, the committee reported HB870 favorably as amended. The transcript shows the committee adopted the amendment set and moved HB870 forward by voice consent; no roll‑call tally appears in the record.
What happens next: With the net‑cost definition and reporting requirement adopted, HB870 advances to the Senate floor as amended. Stakeholders signaled they would continue negotiations over ERISA carveouts and language tightness before final passage.
