Requires drug manufacturers to limit pricing of GLP-1 medications for health insurance plans

House Bill 920 enacts two new statutory provisions to regulate pricing and coverage of glucagon-like peptide-1 medications. The bill creates R.S. 22:1034.2, which establishes limits on cost-sharing requirements that health coverage plans may impose on GLP-1 medications included in their drug formularies. Under this provision, health coverage plans cannot require an insured or enrollee to pay more than two hundred dollars per prescription for a thirty-day supply of any GLP-1 medication, regardless of the specific medication type or the insured's medical condition or diagnosis. The bill also creates R.S. 40:1259.11, which requires the Louisiana Medicaid program to provide coverage for GLP-1 medications to all eligible Medicaid beneficiaries without regard to the enrollee's specific medical condition or diagnosis when prescribed by a provider. The Medicaid provision authorizes the Louisiana Department of Health to seek federal waiver approval and state plan amendments necessary to implement this coverage requirement.

These provisions affect multiple categories of individuals and entities. Insured individuals and health plan enrollees will benefit from a capped out-of-pocket cost of two hundred dollars per thirty-day supply when obtaining GLP-1 medications through covered health insurance plans. Louisiana Medicaid eligible persons gain access to coverage for these medications without prior authorization restrictions based on medical diagnosis. Health insurance carriers offering coverage plans in Louisiana must modify their formulary cost-sharing structures to comply with the two-hundred-dollar cap. The Louisiana Department of Health must work with federal Centers for Medicare and Medicaid Services to obtain the necessary federal approvals to extend Medicaid coverage under the new statutory requirement.

The bill operates within Louisiana's existing insurance regulatory framework codified in Title 22 and the state's Medicaid program structure under Title 40. R.S. 22:1034.2 integrates with existing definitions of drug formularies, enrollees, and health coverage plans already established in Louisiana insurance law. The provision applies to health coverage plans as defined in R.S. 22:1034.1, bringing GLP-1 medications within the scope of existing formulary management requirements. The Medicaid provision must comply with federal requirements under Title XIX of the Social Security Act, making federal waiver approval a prerequisite for full implementation. The bill addresses a gap in existing state law by establishing both a uniform cost-sharing ceiling for commercially insured populations and mandatory coverage standards for the state's Medicaid program.