Pharmacy Benefits Managers – Network Adequacy, Credentialing, and Reimbursement
Impact
The legislation aims to reform the standards governing PBMs, especially regarding the reimbursement they provide to pharmacies. It alters existing requirements to ensure that pharmacies are fairly compensated, particularly stating that pharmacies may refuse to dispense medications if the reimbursement does not cover their acquisition costs. This provision aims to protect independent and smaller pharmacies from financial losses, ensuring they can remain viable and continue to serve their communities.
Summary
House Bill 1006 addresses the role and responsibilities of pharmacy benefits managers (PBMs) in maintaining accessible and adequate pharmacy networks. The bill mandates that PBMs must ensure a reasonably adequate network of pharmacies for beneficiaries, thus requiring them to evaluate geographical and accessibility factors. It prohibits PBMs from imposing unnecessary accreditation or credentialing requirements on pharmacies, simplifying the process for pharmacies to participate in these networks and ensuring wider access to pharmacy services for patients.
Contention
While proponents argue that the bill will enhance access to pharmacy services and support local pharmacies, there may be concerns from larger PBMs about the financial implications of increased regulation. Some stakeholders may worry that the bill could lead to higher costs for health plans, potentially affecting overall healthcare expenditures in the state. The balance between ensuring adequate pharmacy access and managing costs within the healthcare system is likely to be a point of discussion among legislators and stakeholders as HB1006 moves through the legislative process.
Relating to certain contracts between pharmacy benefit managers and the Employees Retirement System of Texas, the Teacher Retirement System of Texas, The Texas A&M University System, or The University of Texas System.
Relating to certain contracts between pharmacy benefit managers and the Employees Retirement System of Texas, the Teacher Retirement System of Texas, The Texas A&M University System, or The University of Texas System.