HB 264 overhauls Louisiana’s regulation of pharmacy benefit managers (PBMs) by imposing new transparency, reimbursement, and anti-steering requirements. The bill defines key PBM practices such as spread pricing, effective rate pricing, rebates, and compensation programs, and it bars PBMs from retaining manufacturer rebates. Instead, rebates must be passed through to the plan sponsor as lower premiums, reduced patient cost-sharing, or broader drug coverage. It also requires PBMs to disclose fees in contracts, file annual transparency reports, and certify compliance to the commissioner of insurance.
The bill also sets reimbursement rules for local Louisiana pharmacies, effective January 1, 2026, requiring PBMs to use a reimbursement formula tied to NADAC or an approved alternative benchmark and to maintain an appeal process when reimbursement falls below acquisition cost. PBMs may not reimburse local pharmacies below acquisition cost, and they must correct claim payment errors through additional payment or retroactive adjustments. The commissioner of insurance is given authority to review PBM compensation programs and examine records to verify transparency reports, while the attorney general receives independent enforcement authority, including the ability to seek restitution, treble damages, and attorney fees. The bill also creates a Pharmacy Benefit Manager Enforcement Fund and establishes a monitoring advisory council within the Department of Insurance.
HB 264’s impact on state law is substantial: it amends multiple provisions in Titles 22, 40, and 44, repeals several older PBM-related statutes, and adds new public records exceptions for certain confidential PBM information. It also expands prohibited conduct to include spread pricing and effective rate pricing for local pharmacies, and it restricts patient steering to pharmacies in which a PBM has an ownership interest or control unless written disclosure and patient acknowledgment are provided. Enforcement of the spread pricing and rebate-retention provisions, and the patient steering restriction, is delayed until January 1, 2027.
The general sentiment reflected in the bill’s voting history is strongly supportive and bipartisan. The House passed the bill 85-0, the Senate passed it 38-0, and the House later concurred in Senate amendments by a vote of 99-0. That unanimous support suggests broad agreement that PBM pricing practices and rebate retention warranted tighter oversight and consumer-facing transparency.
There is little recorded committee controversy in the provided materials, but the structure of the bill indicates the main points of tension are likely to be PBM business practices and pharmacy reimbursement levels. The bill directly limits PBM flexibility by banning rebate retention, spread pricing, and effective rate pricing for local pharmacies, while also giving regulators and the attorney general stronger audit and enforcement powers. Those changes favor local pharmacies, plan sponsors, and patients seeking lower costs, and they may be viewed as burdensome by PBMs, insurers, and vertically integrated pharmacy systems.
HB 264 amends Louisiana insurance, pharmacy, and public records law to regulate PBMs more aggressively. It creates new statutory definitions and duties, requires annual transparency reporting and commissioner review, prohibits rebate retention and certain pricing practices, and establishes reimbursement and appeal rights for local pharmacies. It also creates a special enforcement fund, expands enforcement authority for the commissioner and attorney general, and adds confidentiality protections for certain PBM information from public disclosure.
The bill appears to have had overwhelmingly positive and bipartisan support. It passed the House and Senate unanimously, and the House later concurred in Senate amendments unanimously as well. The vote pattern indicates broad legislative agreement that PBM transparency and pharmacy reimbursement reforms were needed.
The principal policy disputes underlying HB 264 involve PBM compensation models, rebate retention, spread pricing, and patient steering. The bill favors local pharmacies by requiring reimbursement at or above acquisition cost and limiting pricing practices that can reduce pharmacy payments, while PBMs and affiliated entities may object to the loss of rebate retention and reduced pricing discretion. The bill also gives regulators and the attorney general significant oversight and enforcement authority, which may be a point of concern for industry stakeholders.