HB 477 requires most health insurance plans in Louisiana (effective January 2027) to cover prosthetic devices (like artificial limbs) and custom orthotic devices (like braces) for medical necessity. It mandates coverage for the devices, materials, repair, replacement (without lifetime limits), instruction, and special adaptations for bathing or physical activities like running. Insurance plans must follow federal payment standards (based on Medicare rates) and base coverage decisions on a physician’s or advanced provider’s medical necessity determination, with clear appeal processes for denials. This directly affects insured Louisianans needing these devices and insurers offering health coverage in the state.
HB 301 creates the "Independent Contractor Voluntary Portable Benefits Act," allowing independent contractors in Louisiana to establish portable benefit accounts. These accounts, owned by the contractor and not tied to any specific employer, can be funded through voluntary contributions from hiring parties (like companies) or the contractors themselves, with clear opt-in and opt-out requirements. Key provisions include allowing contributions for health insurance, retirement, disability, and other benefits, while explicitly stating these contributions cannot be used to determine employment status or create employer liability under state labor laws. The bill directly affects independent contractors by providing a mechanism to access portable benefits across multiple clients.
HB 920 requires drug manufacturers to limit out-of-pocket costs for GLP-1 medications (used for diabetes and obesity treatment) under health insurance plans in Louisiana. It caps patient costs at $200 per 30-day prescription, regardless of the specific medication or medical condition. The bill also mandates that Louisiana Medicaid cover GLP-1 medications without condition-based restrictions when prescribed. These provisions apply to all health coverage plans, including Medicaid, and may require federal waiver approvals for implementation. The bill is currently in the prefiling stage with no votes recorded.
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 84 requires all health insurance plans sold in Louisiana to cover prostate cancer screening for men aged 40-49 (as medically appropriate) and men over 50, following National Comprehensive Cancer Network guidelines. It mandates that insurers cover these screenings without any out-of-pocket costs for enrollees, including deductibles, copays, or coinsurance. The law applies to new policies starting January 1, 2027, and existing policies must comply by January 1, 2028. This directly affects Louisiana health insurers and their policyholders by guaranteeing no-cost access to recommended prostate cancer screenings.
HB 870 requires Louisiana health insurance issuers to immediately place cheaper generic drugs and biosimilars on more favorable formulary tiers (with lower out-of-pocket costs) when their wholesale acquisition cost is lower than the brand-name reference drug or product. Specifically, if a generic drug costs less than its brand-name equivalent at launch, insurers must cover it with better cost-sharing and cannot impose prior authorization, step therapy, or pharmacy restrictions that make it harder to access than the brand. The same rules apply to biosimilars that are cheaper than their reference biological products. This directly affects health insurance plans and enrollees seeking coverage for these cost-effective alternatives. The bill aims to reduce patient costs by mandating insurer action when cheaper, equivalent options become available.
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.
HB 938 requires pharmacy benefit managers (PBMs) in Louisiana to reimburse pharmacies at the National Average Drug Acquisition Cost (NADAC) plus a standard dispensing fee for all prescriptions, regardless of whether the pharmacy is independent or affiliated with the PBM. It prohibits PBMs from retaining rebates from drug manufacturers, mandating that all rebates be passed through to health plan sponsors as lower premiums, reduced patient costs, or broader coverage. The bill also limits payment errors to a 2% rate for prescription claims, establishes a formal appeal process for pharmacies disputing underpayments, and grants state regulators access to PBM data for oversight. This directly affects Louisiana pharmacies, PBMs, and health plans by standardizing payments, increasing transparency, and reducing financial disputes.
SB 155 requires Louisiana health insurers to cover medically necessary dental procedures directly related to cancer treatment, such as infection prevention/treatment or addressing tooth decay caused by chemotherapy, radiation, or biological therapy. It specifically covers procedures within 30 days before treatment, during treatment, or as a result of treatment (including obturators for oral cavity defects), but excludes routine preventive care like cleanings. The law applies to all new health insurance plans issued on or after January 1, 2027, with existing plans required to comply by January 1, 2028. It does not apply to short-term policies, limited-benefit plans, or excepted benefits.
HB 89 ensures that retired district attorneys and assistant district attorneys in Louisiana's Third Judicial District with at least 24 years of full-time service receive full coverage for their health insurance premiums. The district attorney's office will pay 100% of the premium - either the retiree's current plan or the equivalent amount paid by a current employee - regardless of age. Once retirees become Medicare-eligible, the office continues covering their supplemental plan premiums to maintain comparable coverage. This applies only to retirees who retire after the bill's effective date.
