CorVel is a national provider of industry leading workers’ compensation solutions to Louisiana payors. Incidents and injuries can be reported to our 24/7 call center, to the online claims system or via mobile apps. Reports are immediately processed by our proprietary rules engine where medical management begins immediately as needed, and the claim is assigned to a Claims Adjuster within one business day or less of initial receipt.
Our comprehensive return to work program ensures collaboration and communication with all interested parties including the injured worker, employer, human resources, medical and safety teams, and healthcare providers. We use technology, compassionate case management for employees and cost containment measures, to give Louisiana employers a superior program.
As a service to our clients, CorVel is providing links to information related to the COVID-19 pandemic provided by the states.
Louisiana has released the following updates in response to the COVID-19 outbreak:
Legislature Status: Legislature met briefly on March 31, suspended indefinitely.
SB 160 – Provides for the creation of a workers’ compensation pharmacy formulary
Issues: Workers’ Compensation (Prescription Drug Formulary), Workers’ Compensation (General)
This measure requires that the formulary use the same criteria as used for the development of the medical treatment guidelines. As it relates to the formulary, this measure states that the OWC Assistant Secretary may adopt an existing formulary. This measure further states, in determining which formulary to adopt, the Assistant Secretary will consider the following factors:
(1) Whether the formulary is written for specifically for workers’ compensation.
(2) Whether the formulary includes measures to aid in the management of opioid medications.
(3) Whether the formulary appropriately limits both the duration and the dosage of prescriptions.
(4) The cost of implementation of the formulary.
(5) Whether the formulary is self-updating.
This measure requires that the formulary will be updated when deemed necessary by the OWC Assistant Secretary.
This measure also requires that any prior authorization of a pharmacy or healthcare provider dispensing prescription medications, regardless of classification or lack of classification must follow existing laws.
Most Recent Update: This measure failed to pass the Louisiana State Legislature by the June 1st adjournment date. This measure will not receive further consideration.
SB 41 – Relating to regulation of pharmacy benefit managers
Issues: Workers’ Compensation (Pharmacy Fee Schedule), Special Request
This measure establishes provisions relating to the regulation of pharmacy benefit managers.
Pharmacy Benefit Manager Licensure
This measure no longer requires pharmacy benefit managers to be licensed by the Louisiana Board of Medical Examiners, and licensed by the Louisianian Board of Pharmacy. The measure requires that pharmacy benefit managers will be licensed by the Department of Insurance, as required in present law, in addition to the general requirement that pharmacy benefit managers operating in this state be registered with the Louisiana secretary of state to do business in Louisiana, and may require permitting by the Louisiana Board of Pharmacy if the pharmacy benefit manager performs services that include: (1) Adjudication of appeals or grievances related to prescription drug coverage; (2) Disease management programs; (3) Drug formularies; (4) Drug regimen reviews; (5) Prescription drug management programs; (6) Processing of prior authorization requests; (7) Quality care dosing services; (8) Step therapy procedures; (9) Utilization management and utilization reviews; or (10) any other act or service relating to the compounding, filing, dispensing, exchanging, giving, offering for sale, or selling of drugs, medicines, poisons, or devices in this state by a pharmacist or pharmacy.
The measure states that the Commissioner of Insurance and the Louisiana Board of Pharmacy will be responsible for investigation and enforcement of present law within the Louisiana Insurance Code and applicable provisions of proposed law and present rule relative to pharmacy benefit managers. The measure requires that the Commissioner refer any complaint they believe to be outside of his jurisdiction to the Louisiana Board of Pharmacy or the Louisiana Department of Justice Consumer Affairs Division for review, investigation, and action. Furthermore, the bill authorizes the Commissioner of Insurance to suspend or revoke a pharmacy benefit manager’s permit, license, or registration in accordance with present law and present rule relative to pharmacy benefit managers. The measure further states that instead of authorizing the attorney general to penalize a pharmacy benefit manager for certain violations of proposed law by suspending or revoking any license or permit issued by the Commissioner or the Board, the attorney general may suspend, revoke, or place on probation any permit or license issued to the pharmacy benefit manager or any entity in which the pharmacy benefit manager has an ownership or controlling interest. Additionally, this measure establishes a pharmacy benefit manager monitoring advisory council, and provides guidelines concerning membership and function of such council. Furthermore, this measure removes provisions authorizing the Board of Pharmacy to assess fees of up to $5,000 per violation for pharmacy benefit mangers who operate in this state after filing an attestation without first obtaining a permit.
Maximum Allowable Cost (MAC)
This measure mandates that a pharmacy will not fail to honor maximum allowable cost prices as set forth in the National Drug Code. The measure clarifies that “maximum allowable cost” shall include any term that a pharmacy benefit manager or a healthcare insurer may use to establish reimbursement rates for generic and multi-source brand drugs to a pharmacist or pharmacy for pharmacist services. This measure also mandates that the term “maximum allowable cost list” will not include any rate mutually agreed to and set forth in writing in the contract between the pharmacy benefit manager and the pharmacy or include the National Average Drug Acquisition Cost.
This measure removes the prohibition of mass marketing directed at a beneficiary of a health plan being administered by the pharmacy benefit manager. Instead, the measure prohibits a pharmacy benefit manager from conducting or participating in spread pricing without providing written disclosure and receiving acknowledgement from the patient. Furthermore, this measure requires that such disclosure shall explain that the pharmacy benefit manager has an ownership interest in the pharmacy, and that the patient has the right to use any alternate pharmacy that they choose. The pharmacy benefit manager is prohibited from retaliation or further attempts to influence the patient, or treat the patient or patient’s claim any differently if he or she chooses to use an alternate pharmacy. Moreover, this measure changes the definition of “spread pricing” to mean any amount a pharmacy benefit manager charges or claims from a health plan provider or managed care organization for payment of a prescription or for pharmacy services that is different than, rather than in excess of, the amount the pharmacy benefit manager paid to the pharmacist or pharmacy who filled the prescription or provided the pharmacy services.
This measure prohibits a pharmacy benefit manager from retroactively denying or reducing a claim of a pharmacist or pharmacy for payment, or demanding repayment of all or part of a claim, after the claim has been approved by the pharmacy benefit manager. Additionally, this measure prohibits discrimination against any pharmacist or pharmacy in reimbursing the pharmacy for dispensing a drug, device, or service for less than the amount paid to any other pharmacist or pharmacy for the same drug, device, or service. This measure makes reimbursement parity applicable to local pharmacies. Further, this measure adds a provision which dictates that no pharmacy benefit manager shall charge or pay anyone a fee or surcharge for paying any sales tax or remitting any sales tax proceeds to a pharmacist or pharmacy if that fee or surcharge would be imposed directly or indirectly on the pharmacist or pharmacy. Accordingly, this measure lays out that state and local sales taxes and other applicable state imposed taxes or fees will be considered as part of the allowable cost and will be included in the claim submitted by a pharmacist or pharmacy.
This measure prohibits a PBM from requiring a beneficiary to follow a plan’s step therapy protocol if the prescribed drug is on the health plan’s prescription drug formulary, the beneficiary has tried the step therapy required prescription drug while under his or her current or previous health plan, the provider has submitted a justification and supporting clinical documentation that such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse effect or event.
Additionally, this measure adds a provision detailing that a pharmacy benefit manager shall not delay the decision on a request for authorization to dispense a prescription drug for more than seventy-two hours, or twenty-four hours in exigent circumstances in which the patient, in the opinion of the prescribing provider, pharmacy, or pharmacist submitting the authorization request, is suffering from a health condition that may seriously jeopardize the patient’s life, health, or ability to regain maximum function. This measure mandates that a request for authorization will include relevant data or appropriate documentation to render a decision on a request for authorization.
Mail Order Pharmacy
Further, this measure prohibits a pharmacy benefit manager that owns or controls a mail-order pharmacy from allowing a mail-order pharmacy to repackage drugs and sell the repackaged items at higher prices than the original average wholesale price unless beneficiaries who may buy the repackaged drugs are informed in writing that the drugs have been repackaged and are being sold at the higher price. Further, this measure dictates that a pharmacy benefit manager shall not reimburse a local pharmacist or local pharmacy less than the amount it reimburses chain pharmacies, mail-order pharmacies, specialty pharmacies, or affiliates of the pharmacy service in this state. Additionally, this measure removes the imposition of a fine, to stipulate that the Commissioner of Insurance and the Louisiana Board of Pharmacy will be able to recommend to the Attorney General that either no action be taken against a PBM, or recommend the probation, suspension, or revocation of a license or permit if a PBM is found to be in violation of this Act upon completion of a compliance audit or complaint investigation.
Most Recent Update:
This measure has been signed by Governor John Bel Edwards (D). Section 5 of this measure is effective August 1, 2019. All other sections are effective July 1, 2020.
HB 571 – Provides with respect to plastic and metallic implants or non-autogenous graft
Issues: Workers’ Compensation (Medical Coverage And Reimbursement)
This measure allows healthcare providers who purchase plastic and metallic implant’s or nonautogenous graft’s to be reimbursed for reasonable cost of the implants.
This measure adds that the facility, hospital or ambulatory surgery center, must order and pay for the implant or nonautogenous graft and upon receipt of the original manufacturer’s invoice, must be reimbursed by the payor. Additionally, measure provides that the reimbursed amount must be at the manufacturer’s original invoice amount, exclusive of rebates and discounts, plus 20 percent. This measure requires that a facility will be reimbursed by the payor in accordance with the specifications of the surgeon including the type, number, and manufacturer of the implant.
Most Recent Update: This measure was amended failed to pass the House by a vote of 39-56. This measure is unlikely to receive further consideration.