Texas Senate Bill SB1354

Texas 2025 - 89th Regular

• Filed: 2/18/25

Caption

Relating to the minimum reimbursement amount for prescription drugs and devices to health benefit plan network pharmacists and pharmacies.

Impact

The impact of SB1354 on state laws would be significant as it seeks to amend the Insurance Code by adding provisions that directly affect how PBMs operate and reimburse pharmacists. This change could lead to greater transparency in the billing and reimbursement process related to pharmacy benefits. The bill aims to support pharmacists' financial viability by ensuring that reimbursements align more closely with actual costs incurred during the prescription fulfillment process. Additionally, this could indirectly lead to improved medication access for patients by sustaining local pharmacies which might otherwise struggle under current reimbursement methodologies.

Summary

SB1354 is a legislative proposal that addresses the reimbursement practices of pharmacy benefit managers (PBMs) concerning prescription drugs and devices. The bill stipulates that a PBM cannot reimburse network pharmacists or pharmacies an amount lower than the actual cost of the prescription drug or device dispensed. This establishes a minimum reimbursement threshold, aiming to ensure that pharmacists can cover their costs when dispensing medications. SB1354 seeks to introduce more equitable reimbursement practices within the state's healthcare landscape, focusing on the financial interactions between pharmacists and PBMs.

Contention

There may be contention surrounding SB1354, especially regarding the roles and practices of pharmacy benefit managers. Supporters of the bill, including many pharmacists and pharmacy advocacy groups, argue that it provides necessary regulations to protect pharmacies from potentially exploitative reimbursement practices that could endanger the viability of local pharmacies. Conversely, critics of the bill could argue that such restrictions might limit PBMs' ability to negotiate prices effectively and could potentially lead to increased costs for patients. The discussions surrounding reimbursement methodologies, especially in light of Medicaid and other health coverage systems, could also spark debates about maintaining a balance between controlling healthcare costs and supporting local pharmacy businesses.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1369. Benefits Related To Prescription Drugs And Devices And Related Services
  • Section: New Section