The PBM is required to provide access to its MAC List to each pharmacy subject to the list, update its MAC List on a timely basis, and provide a process for each pharmacy subject to the list to review an update to the MAC List. Law requires the PBM to accept appeals within 15 business days. If an appeal is granted, the PBM shall take all of the following actions: (1) Make the change in the MAC List to the initial date of service the appealed drug was dispensed.(2) Permit the appealing pharmacy and all other pharmacies in the network that filled prescriptions for patients covered under the same health benefit plan to reverse and resubmit claims and receive payment based on the adjusted MAC from the initial date of service the appealed drug was dispensed. (3) Make the change effective for each similarly situated pharmacy as defined by the payor subject to the MAC List and individually notify all pharmacies in the network of that PBM of both of the following: (a) That a retroactive MAC adjustment has been made as a result of a granted appeal effective to the initial date of service the appealed drug was dispensed. (b) That the pharmacy may resubmit and receive payment based upon the adjusted MAC price. (4) Make retroactive price adjustments in the next payment cycle. C. If an appeal made pursuant to this Section is denied, the PBM must provide the challenging pharmacy the NDC of a drug product and source where it may be purchased for a price at or below the MAC from national/regional wholesalers operating in Louisiana. Provides that a violation shall be deemed an unfair or deceptive act and practice.

Link to Existing Law: RS 22:1865

This is a very strong law with robust provisions. Could be considered a model law.