Louisiana Gov. John Bel Edwards (D) has signed legislation stopping insurers or their pharmacy benefit managers from requiring or pressuring in-network providers to obtain physician-administered drugs exclusively from pharmacies in the insurer’s network.
SB 191, which took effect June 1, also bars insurers or PBMs from requiring beneficiaries to pay a fee or any other increased cost-sharing amount to obtain a physician-administered drug when provided by a participating provider. The bill also limits payers and PBMs’ ability to restrict patient choice over where to receive physician-administered drugs.
State Sen. Heather Cloud (R), the bill’s primary sponsor, said it “prevents insurance companies from forcing patients to choose lower quality sites of care for their infusions,” and ends “the disturbing trend of forcing doctors” to obtain physician administered drugs by mail.
“We should never put profits over patients,” Cloud said. “This law is the first of its kind to pass any state legislature.”
Cloud’s bill says insurers or PBMs cannot condition, deny, restrict, refuse to authorize or approve, or reduce payment to participating providers for physician-administered drugs “because the participating provider obtains physician-administered drugs from a pharmacy that is not a participating provider in the health insurance issuer’s network.” Payment must be set at the applicable specified rate in the insurer’s agreement with the provider or, if not such rate is included in the agreement, then at wholesale acquisition cost.
The American Hospital Association, ASHP (American Society of Health-System Pharmacists), and others warn that payer-mandated “white bagging” policies compromise patient safety and weaken efforts to keep counterfeit drugs out of the supply chain. Hospital groups also say when insurers or PBMs stop or obstruct 340B hospitals using in-house or contract specialty pharmacies to buy and bill for specialty drugs, they keep the hospitals from generating income that Congress expressly wanted them to have when it created 340B.
