BATON ROUGE--The 2025 legislative session ended Thursday with lawmakers passing a bill to tighten the rules on companies that work as middlemen managing pharmacy benefits. But the Senate let a more aggressive measure die despite vociferous support for it on social media from Gov. Jeff Landry and Donald Trump Jr.
Now Gov. Jeff Landry is threatening to call a special session to try to pass the tougher bill, which CVS says could force it to close some of its 120 drug stores in Louisiana.
At the center of the dispute are outfits called pharmacy benefit managers, which manage prescription drug benefits for insurers, employers, and government programs like Medicaid.
They claim to help lower drug prices. But investigations by national newspapers and government auditors have found that the largest pharmacy benefit managers often direct patients toward more expensive drugs and charge hidden fees.
In response, several states, led by Arkansas Gov. Sarah Huckabee Sanders, have moved to crack down on their operations, turning the issue into a major one for conservative leaders.
CVS Health, a giant company, is at the center of the fight because it owns a pharmacy benefit manager, CVS Caremark, as well as thousands of drug stores. And when Arkansas passed a law last year prohibiting a company from owning both the benefit management operation and retail stores, CVS said it would have to close more than 20 stores.
It all involves a complicated set of arrangements, and critics say another downside is that the benefit managers have made it hard for independent pharmacies to survive.
But while nearly all lawmakers favor lower drug prices and helping to preserve the independent drugstores, some legislators from rural areas said there are no independent stores left in their towns and that if CVS pulled out, residents would have to drive miles to get to another pharmacy.
Senate President Cameron Henry, R-Metairie, said afterward, the Advocate reported, that there was no reason to rush out the tougher bill—or to call a special session—since the House version would not have taken effect until 2027, and lawmakers could consider it again next year.
When it became clear that the Louisiana Senate was reluctant to rush into the harsher sanctions, the House on Thursday unanimously passed a milder bill, House Bill 264, which increases state oversight of pharmacy benefit managers and their pricing tactics. The Senate had already amended and passed that bill, so House passage Thursday assured that at least that measure would be sent to Landry for his signature.
Tensions had flared further Thursday as Landry and Trump Jr. tweeted their demands for senators to fall into line with more aggressive regulatory demands in House Bill 358, which included a ban on pharmacies owned by pharmacy benefit managers.
Landry took to X, formerly Twitter, to express his support for the legislation and pressure senators to act. He said he remained committed to lowering drug prices for all Louisianans and added that if lawmakers didn’t take meaningful action, “we can come back over the summer to finish it.”
Donald Trump Jr. also posted on X, adding to the political tension, urging Louisiana lawmakers to pass HB 358 as part of broader efforts to lower drug costs.
Even so, that bill failed Thursday after the Senate declined to bring it up before adjournment. Instead, it opted to pass a resolution calling on the state health department to study the potential impact of the tougher rules.
Supporters of the tougher bill blamed its demise on aggressive lobbying by CVS, which sent texts to its pharmacy customers across Louisiana Wednesday saying it might have to close drug stories if that bill passed.
HB358, authored by Rep. Dustin Miller, D-Opelousas, would have allowed pharmacy technicians to work remotely under certain conditions and, more controversially, would have blocked any pharmacy owned or partially controlled by a benefit manager from operating in the state beginning in 2027.
State Republican leaders blasted the texts as inappropriate and accused the company of “fear mongering.” and Louisiana Attorney General Liz Murrill, a close Landry ally, announced plans to investigate CVS over the texts and explore ways to try to prevent the benefit managers and affiliated companies from lobbying customers directly about pending legislation.
Legal experts said such a move could run into First Amendment problems.
The bill that did pass was House Bill 264 by Rep. Michael Echols, R-Monroe, which aims to increase transparency in PBM practices.
It bans “spread pricing,” in which PBMs charge health plans more than they reimburse pharmacies. It requires PBMs to pass 100% of manufacturer rebates to insurers or employers.
The bill also gives the Louisiana Department of Insurance new authority to audit PBM contracts and enforce certification and compliance rules.
The final version also clarified the state’s ability to intervene in cases where the benefit managers deny pharmacy claims, creating a more effective appeals process.
CVS has sued Arkansas over its more extensive bill. Legal observers said a similar court battle could emerge in Louisiana if Landry persuades lawmakers to pass a tougher bill here.