HJNO Mar/Apr 2026

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2026 11 Temple The concept of market concentration has a bit of a different meaning in health coverage than in other sectors, simply because the health benefits market is itself so fragmentary. Louisiana Blue covers the majority of fully-insured lives in Louisiana, but UnitedHealth andAmbetter both have a significant presence in that space, and only about 15% of covered lives in the state fall in that market. When you also consider self- funded plans, Louisiana Blue, United, Cigna, Aetna, and others all have a significant share of the market, and that segment has roughly twice as many lives as the traditional group market at this point. That fragmentation only grows when you also consider the government-sponsored benefits side of the payer mix. The interaction between each of these sectors is complex, and not all are in direct competition with one another. Still, there is clearly a degree of market coordination between the various coverage types, and it prevents much of the real concentration effects you might expect to find if you focused only on one particular area. Editor What is happening with pharmacy benefit managers in Louisiana, and what concerns you most about their role in drug pricing and access? Temple Louisiana has been at the forefront of regulating PBM practices at the state level. That work culminated last year in the enactment of Act 474, which sought to set a reimbursement floor for PBMs, implement a sweeping set of reforms, and bolster my authority to regulate the entities. The overall goal is to ensure that drug prices reflect the actual cost of prescription drugs, rather than being driven by a small group of companies using their unique market control to generate profits without creating value for consumers. The state is at the beginning of some very important and necessary work to dive deep into PBM practices and make sure they’re accountable to consumers and acting in the best interest of their clients. My concern is that we have to ensure both that PBMs are achieving the best prices for insurers and insureds while also preserving the ability of PBMs to negotiate competitively with drug manufacturers. The role of a PBM is to bargain for the best possible price from drug manufacturers. In a world where drug prices are increas- ing dramatically and drug patents provide manufacturers with a strong tool to maxi- mize profits, it is extremely important that we make sure we don’t handicap the PBM in its ability to negotiate the best prices for consumers. So we have two core goals that we must coordinate in regulating the indus- try: a) prevent abusive practices by PBMs; and b) maximize PBMs’ ability to negotiate on behalf of their clients. That’s a very dif- ficult challenge, but it is critically important that we take it on and get it right. Editor As vertical integration accelerates — with insurers owning PBMs, pharmacies, clinics, and data platforms — what risks does this pose for independent physicians, hospitals, and patients in Louisiana, and what authority does your office have to intervene? Temple Vertical integration can reduce costs but it can also lead to anticompetitive practices. Our goal should be to promote laws that protect competition, reduce costs, and maintain the free market. Those are critical touchstones in setting good policy around vertical integration: Companies should be required to treat independent providers and facilities at parity with integrated providers and facilities. That does not mean paying a premium to go independent, but rather that profits from vertical integration need to be based on efficiencies and benefits to consumers and not on steering and self-dealing. Editor Looking ahead five years, what is the single biggest health insurance challenge Louisiana will face? Temple The group health benefits market is essentially divided between fully-insured coverage and self-funded plans. The former are subject to the core reforms of the Affordable Care Act, while the latter are largely exempt. Over the past 10 years, that has led to significant disparities in cost between fully-insured coverage and self-funded plans, pushing more and more employers to seek self-funded coverage. This is both dramatically shrinking the group market — Louisiana has lost roughly 40% of its small-group lives in the last decade — but also making the risk pool much sicker relative to the self-funded market. If that isn’t addressed in the next five years, many states — Louisiana included — will find themselves on a path toward full federalization of their health insurance market. That means a major loss of traditional state authority, a real death of the states’ ability to be test labs for innovation at a time when we clearly need it most, and a significant step toward a fully federalized health economy in this country. I can’t think of a more important challenge. n “The fact that an unusually large proportion of our residents lack the resources to meet their medical needs means that commercial insurance shoulders an especially large share of the cost burden.”