This amendment removes a section about copay assistance plans from the bill while keeping other rules that change how pharmacy benefit managers pay local pharmacies.
Louisiana2026Enacted
HB1236
New Rules for Pharmacy Benefit Manager Payments
Last scannedAug 25, 2026, 3:26 AM
In one sentence
This law sets rules on how pharmacy benefit managers must calculate payments to local pharmacies, including required pricing benchmarks and professional dispensing fees.
What it does
- Requires pharmacy benefit managers to use the National Average Drug Acquisition Cost (NADAC) or wholesale acquisition cost as a pricing benchmark for drug reimbursements.
- Mandates that reimbursement formulas include a professional dispensing fee equal to at least the amount set by the Louisiana Medicaid program.
- Prohibits pharmacy benefit managers from collecting, recouping, or recovering the professional dispensing fee from pharmacies, pharmacists, or members.
- Creates an appeal process for pharmacies to challenge payment errors using written invoices from wholesalers that include specific drug details and costs.
- Allows state officials to request claims-level data to verify that companies are following these new rules.
Who it affects
- Pharmacy benefit managers administering health plan claims
- Local pharmacies in Louisiana
Limits and unknowns
- The law applies retroactively only if pharmacy benefit managers reprocess claims from January 1, 2026, using the new formula.
- Pharmacy benefit managers cannot change what a consumer pays out-of-pocket even when correcting an underpayment to a pharmacy.
Plain language
Terms to know
- Acquisition cost
- The amount a pharmacy actually pays to buy a drug, which cannot be lower than the National Average Drug Acquisition Cost (NADAC).
- Professional dispensing fee
- A payment for services like checking coverage, mixing drugs, counseling patients, and delivering prescriptions that is separate from the cost of the drug itself.
- NADAC
- National Average Drug Acquisition Cost, a standard price list published by federal officials used to calculate reimbursements.
Official record
Sources
Official summary
INSURANCE: Provides relative to pharmacy benefit managers reimbursements (EN +$2,265,844 SG EX See Note)
Official activity
Bill history
- Effective date: 06/12/2026.H
- Signed by the Governor. Becomes Act No. 913.H
- Sent to the Governor for executive approval.H
- Signed by the President of the Senate.S
- Enrolled and signed by the Speaker of the House.H
- Notice of Senate adoption of Conference Committee Report.H
- Conference Committee Report read; adopted by a vote of 35 yeas and 0 nays.S
- Notice House adopted the Conference Committee Report.S
- Conference Committee Report read, roll called, yeas 93, nays 0. The Conference Committee Report was adopted.H
- Scheduled for floor debate on 05/31/2026.H
- Conference Committee report received. Lies over under the rules.H
- Conference committee report received.S
- Notice House Conference Committee members appointed.S
- House conferees appointed: Dewitt, Firment, and Miller.H
- Notice of Senate conferees appointed.H
- Senate conference committee members appointed: Talbot, Bass, and Harris.S
- Notice House rejected the Senate amendments.S
- Read by title, roll called, yeas 99, nays 0, Senate amendments rejected, conference committee appointment pending.H
- Scheduled for concurrence on 05/26/2026.H
- Received from the Senate with amendments.H
Changes
Amendments
6 stored
Filed 5
This amendment updates insurance laws by defining how drug prices are calculated, allowing optional copayment assistance plans for members, and making the new rules apply to costs starting January 1, 2026.
This amendment records a vote where the House of Representatives rejected all changes proposed by the Senate to bill HB1236.
This amendment changes how pharmacy benefit managers must calculate drug reimbursement rates by requiring a specific formula to limit errors, setting minimum fees for pharmacists, and removing several other proposed rules.
This amendment changes how pharmacy benefit managers must calculate drug payments by requiring a specific formula to keep errors low and setting a minimum fee for pharmacists.