84R1569 PMO-F
By: Hinojosa, Nelson S.B. No. 94
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.