Texas 2025 - 89th Regular

Texas House Bill HB4533 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R4791 JG-F
2	2	By: Oliverson H.B. No. 4533
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the reimbursement of prescription drugs under Medicaid
10	10	and the child health plan program.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subchapter F, Chapter 540, Government Code, as
13	13	effective April 1, 2025, is amended by adding Section 540.02731 to
14	14	read as follows:
15	15	Sec. 540.02731. PHARMACY BENEFIT PLAN: REIMBURSEMENT
16	16	METHODOLOGY FOR PRESCRIPTION DRUGS; STUDY. (a) Notwithstanding
17	17	any other law and in accordance with rules the executive
18	18	commissioner adopts, a Medicaid managed care organization or a
19	19	pharmacy benefit manager administering a pharmacy benefit program
20	20	on behalf of the organization shall reimburse a pharmacy or
21	21	pharmacist, including a Texas retail pharmacy or a Texas specialty
22	22	pharmacy, that dispenses a prescribed prescription drug to a
23	23	recipient an amount that is not less than the lesser of:
24	24	(1) the reimbursement amount for the drug under the
25	25	vendor drug program, including a dispensing fee that is not less
26	26	than the dispensing fee for the drug under the vendor drug program;
27	27	or
28	28	(2) the amount claimed by the pharmacy or pharmacist,
29	29	including the gross amount due or the usual and customary charge to
30	30	the public for the drug.
31	31	(b) The methodology the executive commissioner adopts by
32	32	rule to determine Texas pharmacies' actual acquisition cost (AAC)
33	33	for purposes of the vendor drug program must be consistent with the
34	34	actual prices Texas retail pharmacies, Texas specialty pharmacies,
35	35	and Texas long-term care pharmacies, as applicable, pay to acquire
36	36	prescription drugs.
37	37	(c) The executive commissioner shall develop a process for
38	38	determining Texas pharmacies' actual acquisition cost (AAC) for
39	39	prescription drugs that:
40	40	(1) to the extent possible, bases the cost on cost data
41	41	obtained from surveys of Texas pharmacies, including retail,
42	42	specialty, and long-term care pharmacies, conducted by the
43	43	commission on at least a monthly basis; and
44	44	(2) uses an alternative method for determining the
45	45	cost with respect to prescription drugs for which insufficient cost
46	46	data is available from surveys conducted under Subdivision (1).
47	47	(d) The executive commissioner may require Texas pharmacies
48	48	to respond or submit information in response to surveys described
49	49	by Subsection (c)(1) as a condition of participation as a Medicaid
50	50	provider.
51	51	(e) The dispensing fees the executive commissioner adopts
52	52	under Subsection (a) must be based on, as appropriate:
53	53	(1) Texas retail pharmacies' professional dispensing
54	54	costs for retail prescription drugs; or
55	55	(2) Texas specialty pharmacies' professional
56	56	dispensing costs for specialty prescription drugs.
57	57	(f) At least once every two years, the commission shall
58	58	conduct a study of Texas pharmacies' dispensing costs for retail
59	59	prescription drugs and specialty prescription drugs. Based on the
60	60	results of the study, the executive commissioner shall adjust the
61	61	minimum amount of the retail pharmacy professional dispensing fee
62	62	and specialty pharmacy professional dispensing fee under
63	63	Subsection (a).
64	64	(g) A contract to which this subchapter applies must require
65	65	the contracting Medicaid managed care organization and any
66	66	subcontracted pharmacy benefit manager to comply with Subsection
67	67	(a).
68	68	SECTION 2. Subchapter D, Chapter 62, Health and Safety
69	69	Code, is amended by adding Section 62.160 to read as follows:
70	70	Sec. 62.160. PHARMACY BENEFIT PLAN: REIMBURSEMENT
71	71	METHODOLOGY FOR PRESCRIPTION DRUGS. A managed care organization
72	72	providing pharmacy benefits under the child health plan program or
73	73	a pharmacy benefit manager administering a pharmacy benefit program
74	74	on behalf of the organization shall comply with Section 540.02731,
75	75	Government Code.
76	76	SECTION 3. If before implementing any provision of this Act
77	77	a state agency determines that a waiver or authorization from a
78	78	federal agency is necessary for implementation of that provision,
79	79	the agency affected by the provision shall request the waiver or
80	80	authorization and may delay implementing that provision until the
81	81	waiver or authorization is granted.
82	82	SECTION 4. This Act takes effect March 1, 2026.