Texas 2015 - 84th Regular

Texas Senate Bill SB1176 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R7002 PMO-D
2	2	By: Eltife S.B. No. 1176
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the authority and rights of pharmacy services
8	8	administrative organizations to conduct the business of
9	9	independent pharmacies with respect to certain pharmacy benefits.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
12	12	amended by adding Section 843.324 to read as follows:
13	13	Sec. 843.324. PHARMACY SERVICES ADMINISTRATIVE
14	14	ORGANIZATIONS. (a) In this section:
15	15	(1) "Independent pharmacy" means a pharmacy that is
16	16	under common ownership with not more than two other pharmacies.
17	17	(2) "Pharmacy benefit manager" means a person, other
18	18	than a pharmacist, pharmacy, or pharmacy services administrative
19	19	organization, who acts as an administrator in connection with
20	20	pharmacy benefits.
21	21	(3) "Pharmacy services administrative organization"
22	22	means an entity that contracts with an independent pharmacy to
23	23	conduct on behalf of the pharmacy the pharmacy's business with a
24	24	third-party payor, including a pharmacy benefit manager, in
25	25	connection with pharmacy benefits and to assist the pharmacy by
26	26	providing administrative services, including negotiating,
27	27	executing, and administering a contract with a third-party payor
28	28	and communicating with the third-party payor in connection with a
29	29	contract or pharmacy benefits.
30	30	(b) This section applies to a Medicaid managed care program
31	31	and a managed care organization that contracts with the Health and
32	32	Human Services Commission to provide services under Chapter 533,
33	33	Government Code.
34	34	(c) This section does not apply with respect to pharmacy
35	35	benefits under a self-insured, self-funded, or other employee
36	36	welfare benefit plan that is exempt from state regulation under the
37	37	Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
38	38	1001 et seq.).
39	39	(d) Subject to Subsection (e), a pharmacy services
40	40	administrative organization designated and authorized by an
41	41	independent pharmacy as the pharmacy's agent and vested with actual
42	42	authority may conduct the pharmacy's business with a pharmacy
43	43	benefit manager in connection with pharmacy benefits provided under
44	44	a health maintenance organization plan and administered by a
45	45	pharmacy benefit manager.
46	46	(e) Before a pharmacy services administrative organization
47	47	may act on behalf of the independent pharmacy as described by
48	48	Subsection (d), the pharmacy must provide written notice to the
49	49	pharmacy benefit manager that the organization has the authority to
50	50	conduct the pharmacy's business with the pharmacy benefit manager
51	51	to the extent provided in the notice. The notice must detail the
52	52	specific nature and scope of the authority granted to the
53	53	organization with respect to the pharmacy's business with the
54	54	pharmacy benefit manager.
55	55	(f) A pharmacy benefit manager that receives a notice under
56	56	Subsection (e) shall recognize the authority of the pharmacy
57	57	services administrative organization to conduct the pharmacy's
58	58	business with the pharmacy benefit manager to the extent provided
59	59	in the notice. A pharmacy benefit manager may not refuse to deal
60	60	with the organization to the extent of the authority detailed in the
61	61	notice, including by refusing to:
62	62	(1) enter into a contract with the organization acting
63	63	on behalf of the independent pharmacy on terms agreed to by the
64	64	pharmacy benefit manager and organization; or
65	65	(2) communicate with the organization about any matter
66	66	relevant to the pharmacy or pharmacy benefits, including contract
67	67	provisions, maximum allowable cost lists, and reimbursement price
68	68	appeals.
69	69	(g) A pharmacy benefit manager may not require an
70	70	independent pharmacy acting through a pharmacy services
71	71	administrative organization under this section to participate as a
72	72	network provider or preferred provider under a particular health
73	73	benefit plan as a condition of participating as a network provider
74	74	or preferred provider under another health benefit plan.
75	75	(h) A pharmacy services administrative organization has the
76	76	same rights and obligations under this chapter as the independent
77	77	pharmacy on behalf of which the organization acts with respect to
78	78	pharmacy benefits provided under a health maintenance organization
79	79	plan and administered by a pharmacy benefit manager, to the extent
80	80	of the organization's authority to act with respect to those
81	81	benefits.
82	82	SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is
83	83	amended by adding Section 1301.070 to read as follows:
84	84	Sec. 1301.070. PHARMACY SERVICES ADMINISTRATIVE
85	85	ORGANIZATIONS. (a) In this section:
86	86	(1) "Independent pharmacy" means a pharmacy that is
87	87	under common ownership with not more than two other pharmacies.
88	88	(2) "Pharmacy benefit manager" means a person, other
89	89	than a pharmacist, pharmacy, or pharmacy services administrative
90	90	organization, who acts as an administrator in connection with
91	91	pharmacy benefits.
92	92	(3) "Pharmacy services administrative organization"
93	93	means an entity that contracts with an independent pharmacy to
94	94	conduct on behalf of the pharmacy the pharmacy's business with a
95	95	third-party payor, including a pharmacy benefit manager, in
96	96	connection with pharmacy benefits and to assist the pharmacy by
97	97	providing administrative services, including negotiating,
98	98	executing, and administering a contract with a third-party payor
99	99	and communicating with the third-party payor in connection with a
100	100	contract or pharmacy benefits.
101	101	(b) Notwithstanding Section 1301.0041, this section applies
102	102	to a Medicaid managed care program and a managed care organization
103	103	that contracts with the Health and Human Services Commission to
104	104	provide services under Chapter 533, Government Code.
105	105	(c) This section does not apply with respect to pharmacy
106	106	benefits under a self-insured, self-funded, or other employee
107	107	welfare benefit plan that is exempt from state regulation under the
108	108	Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
109	109	1001 et seq.).
110	110	(d) Subject to Subsection (e), a pharmacy services
111	111	administrative organization designated and authorized by an
112	112	independent pharmacy as the pharmacy's agent and vested with actual
113	113	authority may conduct the pharmacy's business with a pharmacy
114	114	benefit manager in connection with pharmacy benefits provided under
115	115	a preferred provider benefit plan and administered by a pharmacy
116	116	benefit manager.
117	117	(e) Before a pharmacy services administrative organization
118	118	may act on behalf of the independent pharmacy as described by
119	119	Subsection (d), the pharmacy must provide written notice to the
120	120	pharmacy benefit manager that the organization has the authority to
121	121	conduct the pharmacy's business with the pharmacy benefit manager
122	122	to the extent provided in the notice. The notice must detail the
123	123	specific nature and scope of the authority granted to the
124	124	organization with respect to the pharmacy's business with the
125	125	pharmacy benefit manager.
126	126	(f) A pharmacy benefit manager that receives a notice under
127	127	Subsection (e) shall recognize the authority of the pharmacy
128	128	services administrative organization to conduct the pharmacy's
129	129	business with the pharmacy benefit manager to the extent provided
130	130	in the notice. A pharmacy benefit manager may not refuse to deal
131	131	with the organization to the extent of the authority detailed in the
132	132	notice, including by refusing to:
133	133	(1) enter into a contract with the organization acting
134	134	on behalf of the independent pharmacy on terms agreed to by the
135	135	pharmacy benefit manager and organization; or
136	136	(2) communicate with the organization about any matter
137	137	relevant to the pharmacy or pharmacy benefits, including contract
138	138	provisions, maximum allowable cost lists, and reimbursement price
139	139	appeals.
140	140	(g) A pharmacy benefit manager may not require an
141	141	independent pharmacy acting through a pharmacy services
142	142	administrative organization under this section to participate as a
143	143	network provider or preferred provider under a particular health
144	144	benefit plan as a condition of participating as a network provider
145	145	or preferred provider under another health benefit plan.
146	146	(h) A pharmacy services administrative organization has the
147	147	same rights and obligations under this chapter as the independent
148	148	pharmacy on behalf of which the organization acts with respect to
149	149	pharmacy benefits provided under a preferred provider benefit plan
150	150	and administered by a pharmacy benefit manager, to the extent of the
151	151	organization's authority to act with respect to those benefits.
152	152	SECTION 3. This Act applies only to benefits provided under
153	153	a health benefit plan that is delivered, issued for delivery, or
154	154	renewed on or after the effective date of this Act. Benefits
155	155	provided under a health benefit plan delivered, issued for
156	156	delivery, or renewed before the effective date of this Act are
157	157	governed by the law as it existed immediately before the effective
158	158	date of this Act, and that law is continued in effect for that
159	159	purpose.
160	160	SECTION 4. This Act takes effect September 1, 2015.