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.