By: Hinojosa, Nelson, Schwertner S.B. No. 94
(In the Senate - Filed November 10, 2014; January 26, 2015,
read first time and referred to Committee on Business and Commerce;
March 31, 2015, reported favorably by the following vote: Yeas 7,
Nays 0; March 31, 2015, sent to printer.)
Click here to see the committee vote
A BILL TO BE ENTITLED
AN ACT
relating to certain fees charged for the adjudication of pharmacy
benefit claims.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1369, Insurance Code, is amended by
adding Subchapter I to read as follows:
SUBCHAPTER I. PHARMACY BENEFIT CLAIM ADJUDICATION
Sec. 1369.401. DEFINITION. In this subchapter, "pharmacy
benefit manager" has the meaning assigned by Section 4151.151.
Sec. 1369.402. CERTAIN FEES PROHIBITED. A health benefit
plan issuer or a pharmacy benefit manager may not directly or
indirectly charge or hold a pharmacist or pharmacy responsible for
a fee for any step of or component or mechanism related to the claim
adjudication process, including:
(1) the adjudication of a pharmacy benefit claim;
(2) the processing or transmission of a pharmacy
benefit claim;
(3) the development or management of a claim
processing or adjudication network; or
(4) participation in a claim processing or
adjudication network.
SECTION 2. The change in law made by this Act does not
affect the terms of a contract, if any, entered into or renewed
before the effective date of this Act until a renewal of the
contract that occurs on or after the effective date of this Act.
SECTION 3. This Act takes effect September 1, 2015.
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