Bill > HB3317

This bill addresses the relationship between pharmacists, pharmacies, health benefit plan issuers, and pharmacy benefit managers (PBMs) by introducing several key provisions. The bill requires that group numbers on health plan identification cards be assigned only to specific enrollees and establishes new rules for claim audits and recoupments, allowing PBMs to recoup payments only under specific circumstances such as fraudulent claims or significant errors. The legislation mandates that health benefit plan issuers and PBMs provide pharmacists and pharmacies with online access to their network contracts, and introduces strict guidelines for making changes to these contracts. Specifically, any "adverse material changes" that would decrease a pharmacist's compensation or change their network tier must be mutually agreed upon, with a 120-day notice period and clear disclosure requirements. The bill also prohibits PBMs from charging participation fees before providing full contract details, prevents mandatory network participation, and requires that all financial terms be clearly stated in contracts. These provisions aim to create more transparency and fairness in the relationship between pharmacies and health benefit plan administrators, giving pharmacists more protection and clarity in their contractual arrangements. The bill will take effect on September 1, 2025, and will apply to new and renewed health benefit plans and contracts from that date forward.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB3317