Texas House Bill HB2978

Texas 2025 - 89th Regular

• Filed: 2/18/25

Caption

Relating to the minimum reimbursement amount for prescription drugs and devices to health benefit plan network pharmacists and pharmacies.

Impact

The proposed changes under HB 2978 are significant for network pharmacists and pharmacies, as it directly addresses reimbursement rates that have been historically seen as inadequate. By ensuring that pharmacists cannot be reimbursed below their actual costs, the bill aims to stabilize pharmacy operations and potentially improve access to prescription medications for patients. The effective date for this legislation is set for September 1, 2025, applying to health benefit plans issued or renewed thereafter.

Summary

House Bill 2978 aims to establish a minimum reimbursement amount for prescription drugs and devices provided by network pharmacists and pharmacies under health benefit plans. This bill modifies the Insurance Code by adding provisions that prevent pharmacy benefit managers from reimbursing pharmacists or pharmacies below their actual acquisition costs for these drugs or devices. Furthermore, it requires that dispensing fees be at least equal to those provided under the Medicaid fee-for-service model.

Contention

However, there are some notable points of contention surrounding this bill. Critics may argue that while the bill aims to support pharmacies, it could lead to increased costs for health benefit plans and, eventually, higher premiums for consumers. Additionally, the exceptions outlined where the bill does not apply, such as Medicaid and TRICARE, could create disparities in reimbursement practices. Stakeholders such as insurance companies may raise concerns about the impact on their negotiations with pharmacies and the overall drug pricing landscape.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1369. Benefits Related To Prescription Drugs And Devices And Related Services
  • Section: New Section