Texas House Bill HB1775

Texas 2015 - 84th Regular

Caption

Relating to the use of maximum allowable cost lists related to pharmacy benefits.

Impact

The bill aims to increase transparency and accountability regarding drug pricing within Texas healthcare. This would affect how pharmacy benefit managers and health plans set prices for medications, ensuring a standardized approach to pricing that could potentially alleviate some burdens on pharmacists and healthcare providers. By requiring regular updates and disclosures, HB1775 aims to create a fairer drug pricing environment, minimizing unexpected price fluctuations for pharmacies.

Summary

House Bill 1775 introduces regulations concerning the use of maximum allowable cost (MAC) lists in pharmacy benefits. It amends Chapter 1369 of the Insurance Code, establishing clear criteria for which drugs can be included on MAC lists. Specifically, drugs must be generically available from national or regional wholesalers and not obsolete. This sets a framework for health benefit plan issuers and pharmacy benefit managers to follow, requiring them to disclose pricing data sources to pharmacies and implement procedures for updating MAC prices regularly.

Contention

One of the notable points of contention surrounding HB1775 lies in its implications for the relationship between pharmacies and health benefit managers. While proponents argue that it creates a fair and transparent system for drug pricing, critics may express concerns over the administrative burden it places on smaller pharmacies to navigate the appeals process for MAC determinations. The ability to appeal price determinations could be seen as a double-edged sword; although it offers a remedy, it may also invite disputes that could exacerbate existing tensions in the healthcare system, particularly for smaller players in the pharmacy sector.