Bill > HB4533

This bill establishes new rules for how Medicaid managed care organizations and pharmacy benefit managers (PBMs) must reimburse pharmacies for prescription drugs in Texas. The legislation requires these organizations to pay pharmacies an amount that is not less than the lesser of two options: the reimbursement amount under the vendor drug program (including a specific dispensing fee) or the amount claimed by the pharmacy. The executive commissioner of health and human services is mandated to develop a process for determining pharmacies' actual acquisition cost (AAC) for prescription drugs, primarily through monthly surveys of Texas pharmacies, including retail, specialty, and long-term care pharmacies. Pharmacies may be required to respond to these surveys as a condition of participating in Medicaid. The bill also requires that dispensing fees be based on the professional dispensing costs of Texas retail and specialty pharmacies, with a requirement to conduct a study of these costs at least every two years and adjust fees accordingly. Additionally, the bill extends these reimbursement requirements to the child health plan program, ensuring consistent pharmacy reimbursement practices across different state healthcare programs. The provisions will take effect on March 1, 2026, and the bill allows for potential delays in implementation if federal waivers are needed.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4533