Louisiana moved from an acquisition-cost floor to a NADAC-based reimbursement formula. Under Act 474 (2025), codified at La. R.S. 22:1868, a PBM may not reimburse a Louisiana “local pharmacy” less than its acquisition cost — expressly defined as NADAC — and from January 1, 2026 must build reimbursement from a NADAC benchmark plus a professional dispensing fee.
A pharmacy may appeal a payment below acquisition cost within 15 days, supported by a wholesaler invoice; if the appeal is upheld the PBM must pay the difference and adjust similarly situated pharmacies. The law applies to “local” pharmacies (Louisiana-domiciled, fewer than 10 outlets) and excludes the state employee plan (Office of Group Benefits). It replaces a narrower acquisition-cost floor that the 2024 SB 444 put in place for 2025.