Texas Senate Bill SB2261

Texas 2019 - 86th Regular

Caption

Relating to the practices and operation of pharmacy benefit managers; providing administrative penalties.

Impact

The passage of SB2261 is expected to enhance the protection of pharmacies and promote fair reimbursement practices. By limiting the ability of PBMs to retroactively alter claims, the bill provides pharmacists with increased financial security and clarity in their operations. Additionally, it mandates that PBMs disclose relevant pricing information and their contractual dealings with drug manufacturers, thereby fostering a more transparent pharmacy benefit market.

Summary

SB2261 aims to regulate the practices and operations of pharmacy benefit managers (PBMs) in Texas. The bill introduces provisions that restrict PBMs from retroactively denying or reducing claims for pharmacy services unless they demonstrate clear evidence of fraud, intentional misrepresentation, or financial harm. Furthermore, it establishes a mandatory appeals procedure for pharmacists and pharmacies when pricing decisions are disputed, including requirements for transparency and accountability regarding pricing information and related practices.

Contention

Notable points of contention surrounding SB2261 involve the potential increased administrative burden on PBMs, which some stakeholders argue could lead to higher costs in the long run. Conversely, advocates for the bill highlight the need for improved practices and ethical standards in line with pharmacy operations. Opponents of the bill have raised concerns about possible unintended consequences that may arise from the more stringent regulations placed on PBMs, which could ultimately affect drug pricing and accessibility for patients.