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No significant fiscal implication to the State is anticipated.
No fiscal implication to units of local government is anticipated.
Section 1213.005 of
the Texas Insurance Code currently prohibits health maintenance organizations
(HMOs) and insurance companies that provide health benefit plans from charging
a fee for the submission and adjudication of a healthcare claim. However, pharmacy
benefit managers utilize loopholes in the current law to charge fees for
adjudication of claims.
HB 255 would explicitly
prevent a person who is an administrator for pharmacy benefits, otherwise known
as a pharmacy benefit manager, from charging a pharmacist or pharmacy a fee
when adjudicating a benefit claim.
The healthcare and
health insurance industries are so heavily regulated that they operate in an
environment that bears little to no resemblance to the free market. Because of
the heavy regulation of almost every aspect of these industries, marketplace
distortions and manipulations are common. Unfortunately, the normal
self-correcting implements of a free market economy - from price signals to
supply and demand responses to improved services through competition - range
from substantially muted to nonexistent.
The only way to fix
such distortions and manipulations in heavily regulated industries, short of
wholesale deregulation (which would be preferable), is through further
regulation. This band-aid approach of fixing regulation-induced problems with
added regulation, while it may temporarily solve a problem, further propagates
the cycle of marketplace confusion which leads to fewer choices, less
innovation, and higher consumer prices.
While we understand
the problem this measure is intended to fix, a better long term approach would
be to substantially deregulate the industry and allow the natural remedies of
the free market to take effect. We are neutral on HB 255.