Texas Senate Bill SB528

Texas 2021 - 87th Regular

Caption

Relating to the contractual relationship between a pharmacist or pharmacy and a health benefit plan issuer or pharmacy benefit manager.

Impact

As a result of this bill, various provisions are put in place to govern how PBMs manage contracts and payments. Key stipulations include preventing PBMs from reducing claim payment amounts after adjudication and ensuring equitable reimbursement rates between affiliated and non-affiliated pharmacists. This could have significant repercussions on how pharmacies operate financially under the umbrella of PBM contracts, potentially leading to increased revenues for some pharmacists while standardizing practices across the board.

Summary

SB528 focuses on regulating the contractual relationships between pharmacists, pharmacies, and pharmacy benefit managers (PBMs). The bill aims to protect pharmacists and pharmacies from potentially unfair practices by PBMs, including prohibitions on certain necessary contractual conditions such as accreditation requirements that exceed state and federal mandates. It establishes standards that aim to ensure that pharmacist services are offered fairly and consistently across the state, thereby safeguarding the interests of both pharmacists and their patients.

Contention

Notable points of contention include the balance between regulatory oversight and the freedom of PBMs to manage their networks. Supporters argue that the protections offered will reduce exploitative practices by PBMs affecting pharmacy operations, ensuring fair treatment and operational viability for smaller pharmacies. Conversely, those opposed may cite concerns regarding the potential for increased costs in pharmaceuticals or reduced flexibility for PBMs to negotiate terms they deem necessary in their contractual agreements. Thus, while the bill aims to create fairer ground, its implications for operational costs and market dynamics are debated.