Texas House Bill HB4533

Texas 2025 - 89th Regular

• Filed: 3/12/25

Caption

Relating to the reimbursement of prescription drugs under Medicaid and the child health plan program.

Impact

The passage of HB 4533 is expected to influence state laws significantly concerning the regulation of pharmacy reimbursement strategies. It introduces a structured approach to determining the actual acquisition cost of prescription drugs for pharmacies, effectively establishing guidelines that the Texas Executive Commissioner must adhere to. By instituting a method of disclosure and assessment of pharmacy costs through regular surveys, the bill aims to enhance transparency in pharmacy pricing. The proposed adjustments to dispensing fees based on cost assessments are meant to reflect the actual financial burdens on pharmacists, potentially leading to greater operational sustainability within the pharmacy sector in Texas.

Summary

House Bill 4533 seeks to amend the reimbursement methodology for prescription drugs under the Medicaid program and the Child Health Plan program in Texas. This bill mandates that Medicaid managed care organizations and pharmacy benefit managers reimburse pharmacies involved in the distribution of prescribed drugs. Notably, it establishes a baseline reimbursement amount that must align either with the Texas vendor drug program or the amounts charged by the pharmacies themselves. This ensures that pharmacists receive adequate compensation for services rendered, thus impacting the financial dynamics of pharmaceutical dispensing within these healthcare programs.

Contention

While proponents of HB 4533 argue that it will bolster the financial viability of Texas pharmacies—especially independent ones—there are concerns raised about the implications for the Medicaid program's budget and overall healthcare costs. Critics fear that increasing reimbursement rates may lead to higher expenditures for state healthcare programs, which could have budgetary repercussions and strain resources. Additionally, there may be apprehensions regarding how the bill's implementation could affect access to prescriptions, particularly in underserved areas where pharmacy costs are already a looming concern.

Texas Constitutional Statutes Affected

Government Code

• Chapter 540. Medicaid Managed Care Program
  • Section: New Section

Health And Safety Code

• Chapter 62. Child Health Plan For Certain Low-income Children
  • Section: New Section