1. A. The roles and responsibilities solely within the purview of pharmacy benefit managers are as follows:

   1. 1. administering prescription drug plans for health plan sponsors;
   2. 2. formulary and benefit design support and management;
   3. 3. establishing reimbursement rates and making payments on behalf of health plan sponsors;
   4. 4. establishing and managing pharmacy networks to ensure network adequacy on behalf of health plans;
   5. 5. performing drug utilization management;
   6. 6. administering disease management and drug adherence programs; and
   7. 7. negotiating rebates and discounts from drug manufacturers.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:11, R.S. 22:1641(8), R.S. 22:1655, R.S. 22:1660.1(B)(1), R.S. 22:1660.8, R.S. 22:1660.9(C) and the Administrative Procedure Act, R.S. 49:950 et seq.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Insurance, Office of the Commissioner, LR 48:2300 (September 2022).