§460.36. Pharmacy reimbursement by managed care organizations

A. Words and terms used in this Section shall have the following meanings:

(1) "Department" means the Louisiana Department of Health.

(2) "Legacy Medicaid rate" means the lesser of one of the following:

(a) The published Medicaid fee-for-service reimbursement rate for the combination of the ingredient cost and dispensing fee in use for the current approved Medicaid state plan in effect on the date of service.

(b) The usual and customary charge. This charge shall be the price the provider most frequently charges the general public for the same drug unless otherwise defined in the current approved Medicaid state plan in effect on the date of service.

(c) The pharmacy's submitted charge.

(3) "Local pharmacy" means any pharmacy, domiciled in at least one Louisiana parish that meets both of the following criteria:

(a) Contracts with the managed care organization or the managed care organization's contractor in its own name or through a pharmacy services administration organization and not under the authority of a group purchasing organization.

(b) Has fewer than ten retail outlets under its corporate umbrella.

B., C. Repealed by Acts 2017, No. 301, §2, eff. Oct. 1, 2017.

D. No managed care organization shall pay a local pharmacy a per-prescription reimbursement at a rate less than the legacy Medicaid rate.

E. Repealed by Acts 2017, No. 301, §2, eff. Oct. 1, 2017.

Acts 2015, No. 399, §2; Acts 2017, No. 301, §§1, 2, eff. Oct. 1, 2017.