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Read. Follow. Verify.Louisiana bans pharmacy benefit managers from cutting reimbursement rates and spread pricing
Last action · April 9, 2026: Becomes HB 1236.Sponsor: Jason DeWitt
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What This Bill Proposed
Louisiana House Bill 866 prohibits pharmacy benefit managers (PBMs) and managed care plans from reducing pharmacy reimbursements below specific state benchmarks, bans practices like and , and mandates the use of pass-through pricing for all covered claims starting in 2027.
Independent and retail pharmacies in Louisiana gain guaranteed minimum reimbursement floors tied to state dispensing fees and NADAC pricing, while managed care plans and pharmacy benefit managers face regulatory fines of one hundred thousand dollars or more per violation for noncompliance.
- Pharmacy benefit managers (PBMs) act as intermediaries between health insurance plans and pharmaceutical manufacturers, managing prescription drug benefits and negotiating drug prices. context
- Spread pricing by PBMs has been a subject of increasing state legislative scrutiny nationwide due to concerns over transparency and the financial impact on community and independent pharmacies. context
Who It Would Have Affected
Groups the bill's text would have affected, as described in the record. Being affected is not a position for or against it.
Pharmacies located in this state
Pharmacies are guaranteed minimum reimbursement floors based on NADAC and professional dispensing fees, and are protected from lower affiliate pricing.
Pharmacy benefit managers
Pharmacy benefit managers are prohibited from using spread pricing and steering, must use pass-through pricing, and face fines of one hundred thousand dollars or more per violation for noncompliance.
Managed care plans
Managed care plans must adhere to new reimbursement restrictions and incorporate pass-through pricing requirements into their pharmacy benefit contracts.
Key Facts
- Pharmacy benefit managers and managed care plans are prohibited from reimbursing any Louisiana pharmacy an amount less than the reimbursement formula including the state's professional dispensing fee.
- PBMs cannot reimburse an independent pharmacy less than what the PBM pays to a PBM affiliate, subsidiary, or related entity for dispensing the same drug.
- Reimbursements cannot fall below the most recently published National Average Drug Acquisition Cost (NADAC) plus the state's professional dispensing fee on the date the drug is dispensed.
- If NADAC is unavailable, reimbursements cannot fall below the wholesale acquisition cost plus the state's professional dispensing fee.
Show all 9 facts
- PBMs and managed care plans are expressly prohibited from engaging in spread pricing, steering, and effective rate pricing.
- Direct or indirect spread pricing is banned unless the entire difference between what the third-party payor pays and what the pharmacy receives is passed through to the health plan sponsor.
- PBMs and managed care plans must use pass-through pricing for every covered claim submitted in the state.
- Failure of a PBM to reimburse authorized fees subjects the entity to sanctions by the commissioner, including fines of one hundred thousand dollars or more per violation within a calendar year.
- All applicable contracts executed, amended, adjusted, or renewed on or after July 1, 2026, must enforce the pass-through pricing model for prescription benefits beginning January 1, 2027.
Frequently Asked Questions
What pricing models are prohibited under this bill?
What is the penalty for a pharmacy benefit manager that fails to follow these rules?
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News Coverage
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Votes, people, money & the original sourceWhere This Stands
This bill did not become law - Died at adjournment · in House committee.
Procedural history
6 actions- Apr 9, 2026HouseBecomes HB 1236.
- Apr 8, 2026HouseReported by substitute (12-0).
- Mar 9, 2026HouseIntroducedRead by title, under the rules, referred to the Committee on Insurance.
- Feb 27, 2026HousePrefiled.
- Feb 27, 2026HouseCommitteeUnder the rules, provisionally referred to the Committee on Insurance.
- Feb 27, 2026HouseFirst appeared in the Interim Calendar on 2/27/2026.
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Connected Entities
Sources
www.legis.la.gov
Analysis Score
0–100- Significance20Lowered because this bill did not pass (its text scored 80)
- Controversy65Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz45Current news / social attention level
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