83R6204 PMO-D
By: Hinojosa S.B. No. 1431
A BILL TO BE ENTITLED
AN ACT
relating to pharmacy benefit managers contracting with the child
health plan program, the Medicaid managed care program, and health
plans for certain government employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 531, Government Code, is amended by
adding Subchapter Y to read as follows:
SUBCHAPTER Y. PHARMACY BENEFIT MANAGERS
Sec. 531.990. APPLICABILITY. This subchapter applies only
to a Medicaid managed care program under Chapter 533 and the child
health plan program.
Sec. 531.991. TRANSPARENCY IN PHARMACY BENEFIT MANAGEMENT.
(a) In this section, "maximum allowable cost" means a maximum
reimbursement amount for a group of therapeutically and
pharmaceutically equivalent multiple source medications.
(b) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to:
(1) establish:
(A) a method of calculating, updating, and
revising a maximum allowable cost for each covered medication;
(B) a frequency for updating or revising the
maximum allowable cost; and
(C) a maximum allowable cost list that uniformly
serves as a basis for the calculation of reimbursement amounts for
pharmacy claims covered by the child health plan program or
Medicaid managed care program; and
(2) develop and maintain a public Internet website and
post and maintain on the website the information required by
Subdivision (1).
(c) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to provide to the
commission the information required by Subsection (b)(1). On
request, the commission shall provide the information to a
pharmacist or pharmacy.
SECTION 2. Subchapter B, Chapter 1551, Insurance Code, is
amended by adding Section 1551.0671 to read as follows:
Sec. 1551.0671. TRANSPARENCY IN PHARMACY BENEFIT
MANAGEMENT. (a) In this section, "maximum allowable cost" means a
maximum reimbursement amount for a group of therapeutically and
pharmaceutically equivalent multiple source medications.
(b) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to:
(1) establish:
(A) a method of calculating, updating, and
revising a maximum allowable cost for each covered medication;
(B) a frequency for updating or revising the
maximum allowable cost; and
(C) a maximum allowable cost list that uniformly
serves as a basis for the calculation of reimbursement amounts for
pharmacy claims covered by the group benefits program; and
(2) develop and maintain a public Internet website and
post and maintain on the website the information required by
Subdivision (1).
(c) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to provide to the board of
trustees the information required by Subsection (b)(1). On
request, the board of trustees shall provide the information to a
pharmacist or pharmacy.
SECTION 3. Subchapter C, Chapter 1575, Insurance Code, is
amended by adding Section 1575.111 to read as follows:
Sec. 1575.111. TRANSPARENCY IN PHARMACY BENEFIT
MANAGEMENT. (a) In this section, "maximum allowable cost" means a
maximum reimbursement amount for a group of therapeutically and
pharmaceutically equivalent multiple source medications.
(b) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to:
(1) establish:
(A) a method of calculating, updating, and
revising a maximum allowable cost for each covered medication;
(B) a frequency for updating or revising a
maximum allowable cost; and
(C) a maximum allowable cost list that uniformly
serves as a basis for the calculation of reimbursement amounts for
pharmacy claims covered by the group program; and
(2) develop and maintain a public Internet website and
post and maintain on the website the information required by
Subdivision (1).
(c) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to provide to the trustee
the information required by Subsection (b)(1). On request, the
trustee shall provide the information to a pharmacist or pharmacy.
SECTION 4. Subchapter B, Chapter 1579, Insurance Code, is
amended by adding Section 1579.058 to read as follows:
Sec. 1579.058. TRANSPARENCY IN PHARMACY BENEFIT
MANAGEMENT. (a) In this section, "maximum allowable cost" means a
maximum reimbursement amount for a group of therapeutically and
pharmaceutically equivalent multiple source medications.
(b) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to:
(1) establish:
(A) a method of calculating, updating, and
revising a maximum allowable cost for each covered medication;
(B) a frequency for updating or revising a
maximum allowable cost; and
(C) a maximum allowable cost list that uniformly
serves as a basis for the calculation of reimbursement amounts for
pharmacy claims covered by a health coverage plan; and
(2) develop and maintain a public Internet website and
post and maintain on the website the information required by
Subdivision (1).
(c) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to provide to the trustee
the information required by Subsection (b)(1). On request, the
trustee shall provide the information to a pharmacist or pharmacy.
SECTION 5. Subchapter B, Chapter 1601, Insurance Code, is
amended by adding Section 1601.065 to read as follows:
Sec. 1601.065. TRANSPARENCY IN PHARMACY BENEFIT
MANAGEMENT. (a) In this section, "maximum allowable cost" means a
maximum reimbursement amount for a group of therapeutically and
pharmaceutically equivalent multiple source medications.
(b) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to:
(1) establish:
(A) a method of calculating, updating, and
revising the maximum allowable cost for each covered medication;
(B) a frequency for updating or revising a
maximum allowable cost; and
(C) a maximum allowable cost list that uniformly
serves as a basis for the calculation of reimbursement amounts for
pharmacy claims covered by the basic coverage; and
(2) develop and maintain a public Internet website and
post and maintain on the website the information required by
Subdivision (1).
(c) A contract to provide pharmacy benefit manager services
must require the pharmacy benefit manager to provide to the
governing board of the system the information required by
Subsection (b)(1). On request, the system shall provide the
information to a pharmacist or pharmacy.
SECTION 6. Subchapter Y, Chapter 531, Government Code, and
Sections 1551.0671, 1575.111, 1579.058, and 1601.065, Insurance
Code, as added by this Act, apply only to a contract with a pharmacy
benefit manager executed or renewed on or after the effective date
of this Act.
SECTION 7. This Act takes effect September 1, 2013.