As the 2025 Louisiana legislative session came to a close Thursday, a closely watched bill that aimed to regulate pharmacy benefit managers, or PBMs, failed to make it through the Senate. But it may not be the end of the debate.
Gov. Jeff Landry, who supported the measure, says he plans to call a special session to bring House Bill 358 back to the table. The bill, authored by Rep. Dustin Miller, D-Opelousas, sought to tighten restrictions on PBMs — companies that act as middlemen between insurers, drug manufacturers and pharmacies.
At Thrifty Way Pharmacy in St. Martinville, pharmacist David Darce said local pharmacies are feeling the impact of PBM practices more than ever. "We file a claim with them for the prescription that we're filling and they determine how much our reimbursement is," Darce said. "It used to be something that was negotiated, but now the contracts are you take it or leave it. Sometimes we get paid below cost." For example, if the pharmacy dispenses a medication that costs $400, a PBM might reimburse them just $300, meaning the pharmacy takes a $100 loss on the prescription.
"You can't absorb that type of loss on the margins we're making," he said. "So we're not able to carry the drug, and the patient either has to go someplace else or find a pharmacy that can." PBMs negotiate drug prices and manage pharmacy networks on behalf of health insurers. Some also operate their own retail pharmacies. Critics say this dual role creates conflicts of interest that hurt independent pharmacies and limit patient access.
CVS, which owns both retail pharmacies and the PBM CVS Caremark, sent a mass text to customers in Louisiana calling HB 358 "last minute legislation" and warning it could result in pharmacy closures.
A CVS spokesperson, Amy Thibault, said in a statement,
First and foremost, our focus remains on serving the people of Louisiana: lowering drug costs, providing access to care, and helping improve health. We look forward to working productively with policymakers to continue to make prescription drugs more affordable and accessible and promoting the value of community pharmacy.
If this bill had passed and was signed into law, pharmacy care access would have been limited in Louisiana. It would have forced pharmacies to close. For CVS specifically, it would have meant closing roughly 120 CVS Pharmacy locations, nearly a million patients needing to find a new pharmacy and 2,700 colleagues losing their job. The policy would have led to serious consequences for pharmacy patients across the state.
Darce said PBMs are able to offer lower co-pays at their affiliated pharmacies, creating an uneven playing field. "What we'll see is if they want to fill a prescription here, they might have a $45 copay," Darce said. "But if you go to a PBM-owned pharmacy, it might be zero. A lot of our customers are on a fixed income, and that matters."
Rep. Miller said the bill was meant to create fairness. “PBMs were created to drive the cost of prescriptions down, but instead it has turned into a pharmacy-owned PBM profiting trillions of dollars annually on money that should go to the patient,” Miller said. “The bill simply told companies in Louisiana: You can’t be a pharmacy and a PBM.”
Although HB 358 failed, another related measure — House Bill 264 — did pass. It increases state oversight of PBMs and prohibits "spread pricing," a practice in which PBMs reimburse a pharmacy one price and charge the insurer a higher price, keeping the difference.
"Say, they pay David $100 for a prescription at Thrifty Way Pharmacy, but then turn around and bill the insurance $200," Darce said. "They keep the $100 difference, and the copay is based on the inflated price. It’s just devastating."
With Landry signaling a special session to revisit HB 358, the conversation around PBMs in Louisiana is far from over.
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