By: Eiland H.B. No. 3456
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement rates paid to certain pharmacies in
connection with health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1560.004, Insurance Code, is amended to
read as follows:
Sec. 1560.004. PRESCRIPTION DRUG REIMBURSEMENT RATES. (a)
Except as provided by Subsection (c), an [An] issuer of a health
benefit plan that provides pharmacy benefits to enrollees shall
reimburse pharmacies participating in the health plan using
prescription drug reimbursement rates, for both brand name and
generic prescription drugs, that are based on a current and
nationally recognized benchmark index that includes average
wholesale price and maximum allowable cost.
(b) Except as provided by Subsection (c), regardless
[Regardless] of whether a pharmacy is a mail order pharmacy or a
community retail pharmacy, an issuer of a health benefit plan shall
use the same benchmark index, including the same average wholesale
price, maximum allowable cost, and national prescription drug
codes, to reimburse all pharmacies participating in the health
benefit plan.
(c) An issuer of a health benefit plan shall incorporate
into the calculation under Subsection (b) any monetary or
nonmonetary benefit that a mail order pharmacy receives and that a
community retail pharmacy does not receive in connection with
providing a prescription drug to enrollees.
SECTION 2. Section 1560.004, Insurance Code, as amended by
this Act, applies only to a health benefit plan provided under
Chapter 1551, 1575, or 1579, Insurance Code, beginning with the
2014-2015 plan year. A plan year before 2014-2015 is governed by
the law as it existed immediately before September 1, 2014, and that
law is continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2013.