LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 87TH LEGISLATIVE REGULAR SESSION April 24, 2021 TO: Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: SB2195 by Kolkhorst (Relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan insurers.), Committee Report 1st House, Substituted The fiscal implications of the bill cannot be determined at this time. The bill would amend the Occupations Code and Insurance Code relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan issuers. The bill would prohibit a pharmacy benefit manager (PBM) from directly or indirectly reducing the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim, and prohibit a health benefit plan issuer from requiring higher accreditation standards or recertification requirements than the state or federal government. The bill would also prohibit a PBM from requiring an enrollee to use a mail order pharmacy, and a health benefit care issuer or pharmacy benefit manager from making it a condition of a contract to restrict the pharmacy/pharmacist from mailing or delivering a drug to a patient on their request. The bill would affect plans entered into or renewed on or after September 1, 2021.According to the Health and Human Services Commission (HHSC), the provisions of the bill would limit a PBM's ability to recoup payment from a pharmacy after claims adjudication in cases where a pharmacy did not meet performance metrics. While HHSC anticipates this would result in an increase in pharmacy claims costs, the agency is unable to determine the cost at this time. Local Government ImpactThe fiscal implications of the bill cannot be determined at this time. Source Agencies: b > td > 323 Teacher Retirement System, 327 Employees Retirement System, 454 Department of Insurance, 529 Hlth & Human Svcs Comm, 710 Texas A&M Univ System Admin, 720 UT Sys Admin LBB Staff: b > td > JMc, AKI, MB, MPUK
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 87TH LEGISLATIVE REGULAR SESSION
April 24, 2021
TO: Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: SB2195 by Kolkhorst (Relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan insurers.), Committee Report 1st House, Substituted
TO: Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
FROM: Jerry McGinty, Director, Legislative Budget Board
IN RE: SB2195 by Kolkhorst (Relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan insurers.), Committee Report 1st House, Substituted
Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
Jerry McGinty, Director, Legislative Budget Board
Jerry McGinty, Director, Legislative Budget Board
SB2195 by Kolkhorst (Relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan insurers.), Committee Report 1st House, Substituted
SB2195 by Kolkhorst (Relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan insurers.), Committee Report 1st House, Substituted
The fiscal implications of the bill cannot be determined at this time.
The fiscal implications of the bill cannot be determined at this time.
The bill would amend the Occupations Code and Insurance Code relating to the relationship between pharmacists or pharmacies and pharmacy benefit managers or health benefit plan issuers. The bill would prohibit a pharmacy benefit manager (PBM) from directly or indirectly reducing the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim, and prohibit a health benefit plan issuer from requiring higher accreditation standards or recertification requirements than the state or federal government. The bill would also prohibit a PBM from requiring an enrollee to use a mail order pharmacy, and a health benefit care issuer or pharmacy benefit manager from making it a condition of a contract to restrict the pharmacy/pharmacist from mailing or delivering a drug to a patient on their request. The bill would affect plans entered into or renewed on or after September 1, 2021.According to the Health and Human Services Commission (HHSC), the provisions of the bill would limit a PBM's ability to recoup payment from a pharmacy after claims adjudication in cases where a pharmacy did not meet performance metrics. While HHSC anticipates this would result in an increase in pharmacy claims costs, the agency is unable to determine the cost at this time.
Local Government Impact
The fiscal implications of the bill cannot be determined at this time.
Source Agencies: b > td > 323 Teacher Retirement System, 327 Employees Retirement System, 454 Department of Insurance, 529 Hlth & Human Svcs Comm, 710 Texas A&M Univ System Admin, 720 UT Sys Admin
323 Teacher Retirement System, 327 Employees Retirement System, 454 Department of Insurance, 529 Hlth & Human Svcs Comm, 710 Texas A&M Univ System Admin, 720 UT Sys Admin
LBB Staff: b > td > JMc, AKI, MB, MPUK
JMc, AKI, MB, MPUK