Texas Senate Bill SB679

Texas 2021 - 87th Regular

Caption

Relating to the regulation of pharmacy benefit managers and health benefit plan issuers in relation to prescription drug coverage.

Impact

The bill seeks to mitigate conflicts of interest within the health care industry by prohibiting certain practices by PBMs that may unfairly favor affiliated pharmacies over independent ones. It mandates that health benefit plans must not reduce claim payments for pharmacists post-adjudication, preventing PBMs from manipulating reimbursement structures to their advantage. By imposing restrictions on preferential referrals and steering, SB679 aims to bolster the role of independent pharmacies and ensure that patients have genuine choices in where they receive their medications.

Summary

Senate Bill 679 (SB679) focuses on the regulation of pharmacy benefit managers (PBMs) and health benefit plan issuers in Texas, particularly in relation to prescription drug coverage. This legislation introduces new provisions in the Insurance Code, aiming to ensure transparency and protect both pharmacists and patients from potentially exploitative practices. It establishes a framework for the complaints process against PBMs, allowing the state insurance commissioner to review allegations of misconduct and take appropriate disciplinary actions as needed.

Contention

Notable points of contention surround the balance of power between PBMs and pharmacies. Some stakeholders argue that while the regulation of PBMs is necessary, excessive restrictions may lead to higher costs for consumers and limit the operational flexibility of PBMs in managing costs and services. Moreover, the bill’s impacts on existing laws governing health benefit plans may provoke discussions among legislators and interest groups regarding the trade-offs between consumer protections and the potential for increased costs in prescription drug coverage.