Insurance

HB 1199 mandates that health insurance plans cover genetic testing and treatments for SCN2A-associated medical conditions without imposing cost-sharing fees on members who are covered under their policy. The bill requires insurers to include these specific services in their coverage without charging patients a portion of the cost. This legislation directly affects individuals with SCN2A-related conditions and the health insurance providers who must adjust their benefit structures accordingly.

HB 761 creates an advisory board within Louisiana's Department of Health to review and recommend new treatments for rare cancers. The 17-member board includes health officials, cancer researchers, oncologists from major institutions (like LSU, Tulane, and Xavier), and representatives from cancer research centers. The board must hold quarterly public meetings, compile findings within 30-45 days, and submit written reports to the Insurance Committees of both legislative chambers. This process directly affects how the Department of Health evaluates rare cancer treatments, streamlining recommendations to the agency for potential adoption.

SB 246 requires health insurers and related entities (like pharmacy benefit managers) to disclose when artificial intelligence (AI) is used in denying coverage decisions. The bill prohibits AI from discriminating, violating health regulations, or delaying care, and mandates that AI decisions must be based on individual patient medical history - not group data - and include human review for medical necessity claims and prior authorization requests. Insurers must also conduct quarterly AI performance reviews, allow patients to request AI-related documentation, and cannot use AI in subsequent reviews of appeals where AI was the basis for denial.

SB 363 requires health insurance companies in Louisiana to provide medically necessary treatments as determined by a patient's treating provider, prohibiting substitutions with less intensive care solely based on cost-saving measures. It directly affects health insurance issuers and patients who might face denied or downgraded care. The bill defines "lower level of care" as less intensive treatment than recommended by the provider and specifies that substitutions are only allowed if consistent with standard medical practice and clinically appropriate. This policy change aims to prevent insurers from overriding provider recommendations for financial reasons. The bill is currently pending referral to the Insurance Committee after being prefaced in February 2026.

SB 323 increases penalties for insurance violations related to pharmacy benefits, such as payment for prescription drugs or pharmacist services. It sets a $25,000 fine per violation for pharmacy-related issues (removing the previous $100,000 annual cap) and requires license suspension/revocation if violations aren’t corrected within 30 days of notice. The bill directly affects insurers and entities offering pharmacy benefits under insurance contracts in Louisiana. These changes amend Louisiana Insurance Code sections to strengthen enforcement for pharmacy benefit compliance.