SUBPART C-1. PHARMACY BENEFIT MANAGER'S MAINTENANCE

AND USE OF MAXIMUM ALLOWABLE COST LISTS

FOR PRESCRIPTION DRUGS

§1863. Definitions

            As used in this Subpart, the following definitions apply:

            (1) "Drug Shortage List" means a list of drug products posted on the United States Food and Drug Administration drug shortage website.

            (2) "Maximum Allowable Cost List" means a listing of the National Drug Code used by a pharmacy benefit manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist may be based. "Maximum Allowable Cost List" shall include any term that a pharmacy benefit manager or a healthcare insurer may use to establish reimbursement rates for generic and multi-source brand drugs to a pharmacist or pharmacy for pharmacist services. The term "Maximum Allowable Cost List" shall not include any rate mutually agreed to and set forth in writing in the contract between the pharmacy benefit manager and the pharmacy or its agent and shall not include the National Average Drug Acquisition Cost. A pharmacy benefit manager may use effective rate pricing for a pharmacist or pharmacy that is not a local pharmacy or local pharmacist as defined in R.S. 46:460.36(A).

            (3) "NDC" means the National Drug Code, a numerical identifier assigned to all prescription drugs.

            (4) "Pharmacist" means a licensed pharmacist as defined in R.S. 22:1852(8).

            (5) "Pharmacist services" means products, goods, or services provided as a part of the practice of pharmacy as defined in R.S. 22:1852(9).

            (6) "Pharmacy" means any appropriately licensed place where prescription drugs are dispensed as defined in R.S. 22:1852(10).

            (7) "Pharmacy benefit manager" means an entity that administers or manages a pharmacy benefits plan or program.

            (8) "Pharmacy benefits plan" or "pharmacy benefits program" means a plan or program that pays for, reimburses, covers the cost of, or otherwise provides for pharmacist services to individuals who reside in or are employed in Louisiana.

            (9) "Spread pricing" means any amount a pharmacy benefit manager charges or claims from a health plan provider or managed care organization for payment of a prescription or for pharmacy services that is different than the amount the pharmacy benefit manager paid to the pharmacist or pharmacy who filled the prescription or provided the pharmacy services.

            Acts 2014, No. 391, §1; Acts 2018, No. 597, §1, eff. Jan. 1, 2019; Acts 2019, No. 124, §1, eff. July 1, 2020.