KEY TAKEAWAYS: Baton Rouge judge denied Express Scripts‘ request to block the reimbursement directive. Louisiana pharmacies must be paid at least NADAC plus $9 per 30-day prescription fill. Directive applies to pharmacy benefit managers and insurers licensed in Louisiana. State officials say higher reimbursement costs could eventually increase insurance premiums.   A Baton Rouge judge allowed Louisiana Insurance Commissioner Tim Temple‘s pharmacy reimbursement directive to take effect, denying a request by Express Scripts to keep the order blocked while the case continues. The ruling means the Louisiana Department of Insurance can enforce Temple’s order requiring pharmacy benefit managers to pay local pharmacies at least the National Average Drug Acquisition Cost, or NADAC, plus $9 for a 30-day prescription fill. Judge Alvin Batiste of the 19th Judicial District Court denied Express Scripts’ motion for a preliminary injunction after an April 14 hearing. The court also lifted a temporary restraining order that had previously prevented the Department of Insurance from enforcing the directive. The directive applies to pharmacy benefit managers licensed in Louisiana and health insurers that contract with them. It does not apply to Medicare, Medicaid or Office of Group Benefits plans. The order stems from Act 474, passed during the 2025 legislative session, which required pharmacy benefit managers to use a reimbursement formula that includes three parts: the drug’s acquisition cost, a markup and a professional dispensing fee. Frank Opelka, deputy commissioner for the Louisiana Department of Insurance’s Office of Health, Life and Annuity, said the law clearly defined the drug-cost portion of the formula but left uncertainty over the dispensing fee. “The dispensing fee is really the element of reimbursement for a pharmacy that’s going to cover its overhead,” Opelka said. “But it didn’t define what that dispensing fee was supposed to be reimbursed at. It just said it had to be paid.” The department said there had been confusion since the law took effect Jan. 1 over how much pharmacy benefit managers had to pay pharmacies. After reviewing reimbursement practices, the department found that payments below NADAC plus $9 are not “fair and reasonable” under state law. Opelka said higher reimbursements could eventually be reflected in premiums. “Any cost that gets added is going to wind up being baked into premiums down the road,” Opelka said. “It’s absolutely going to get passed on to consumers. That’s just how insurance works.” ...read more read less