Cost-Sharing Restricted for Certain Drugs

On June 1, 2021, Gov. Edwards signed Senate Bill No. 191 into law, providing that health insurance issuers (and their agents) cannot require participants to pay any other cost-sharing amount (or additional fees) beyond the applicable cost-sharing amounts imposed by plan terms for physician-administered drugs when provided by a participating provider.

The law specifically provides that “a health insurance issuer shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating provider for a physician-administered drug when all criteria for medical necessity are met, because the participating provider obtains physician-administered drugs from a pharmacy that is not a participating provider in the health insurance issuer's network.” However, this law does not prohibit a health insurance issuer (or its agent) from refusing to authorize (or denying) coverage of a physician-administered drug due to failing to satisfy medical necessity criteria.

The goal of the new law is to ensure that patients' choice regarding providers furnishing physician-administered drugs is not impeded (and to make sure patients receive safe and effective drug therapies).

While this guidance does not impact employers directly, they should be aware of these developments.

Senate Bill No. 191 »