Louisiana Revised Statutes 22:1857 – Prescription drugs, products, and supplies; use of index
Terms Used In Louisiana Revised Statutes 22:1857
- Claim: means a request by a pharmacist for payment by a health insurance issuer. See Louisiana Revised Statutes 22:1852
- Contract: A legal written agreement that becomes binding when signed.
- Health insurance issuer: means an insurance company, including a health maintenance organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Title, unless preempted as an employee benefit plan under the Employee Retirement Income Security Act of 1974. See Louisiana Revised Statutes 22:1852
- Pharmacist: means an individual currently licensed as a pharmacist by the Louisiana Board of Pharmacy to engage in the practice of pharmacy in this state. See Louisiana Revised Statutes 22:1852
A. Reimbursement under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricing calculation shall use the most current nationally recognized reference price or amount in the actual or constructive possession of the health insurance issuer, its agent, or any other party responsible for reimbursement for prescription drugs and other products and supplies on the date of service shown on the claim.
B. Health insurance issuers, their agents, and other parties responsible for reimbursement for prescription drugs and other products and supplies shall be required to update the nationally recognized reference prices or amounts used for calculation of reimbursement for prescription drugs and other products and supplies no less than every three business days.
C. Any health insurance issuer, agent, or other party responsible for reimbursement for prescription drugs and other products and supplies that does not comply with the requirements of Subsection A or B of this Section shall be subject to the late payment adjustment provisions of La. Rev. Stat. 22:1854(C) to the extent of any amount not paid in accordance with the requirements of this Section.
Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Acts 2005, No. 209, §1, eff. July 1, 2005; Redesignated from La. Rev. Stat. 22:250.57 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.