LA HB938

Requires pharmacy benefit managers (PBMs) to reimburse all Louisiana pharmacies at the National Average Drug Acquisition Cost (NADAC) plus the Louisiana Medicaid dispensing fee, with no variance in reimbursement between independent and PBM-affiliated pharmacies

Prohibits PBMs from retaining manufacturer rebates, spread pricing, or other price-based revenues; limits PBM income to flat-fee service charges and performance bonuses, with all prohibited revenue passed through quarterly to client health plans

Mandates PBM disclosure to client health plans of claims-level pricing data, pharmacy reimbursements, and prohibited revenue sources within 30 days of request; grants the Insurance Commissioner direct access to this data

Requires the Division of Administration to procure PBM services for state employee group benefits through a competitive reverse auction process, with technology platform procurement at least 4 months before auction completion

Repeals Act No. 474 of the 2025 Regular Session; implementation begins October 1, 2026, with civil penalties up to $5,000 per prescription drug claim for violations