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Relating to the contractual relationship between a pharmacist or pharmacy and a health benefit plan issuer or pharmacy benefit manager.
According to the Legislative Budget Board, no fiscal implication to the state is anticipated.
HB 2817 would prohibit a health benefit plan issuer or pharmacy benefit manager from reducing the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim through the use of an aggregated effective rate, a quality assurance program, other direct or indirect remuneration fee, or otherwise, except under certain provided circumstances.
This bill would require a pharmacy benefit network contract to specify or reference a separate fee schedule. The fee schedule would be provided electronically in an easily accessible and complete spreadsheet format and, on request, in writing to each contracted pharmacy and pharmacist.
Except in cases of fraud, a health benefit plan issuer or pharmacy benefit manager would not be allowed, as a condition of a contract, prohibit a pharmacist or pharmacy from: (1) mailing or delivering a drug to a patient on the patient ’s request, to the extent permitted by law; or (2) charging a shipping and handling fee to a patient requesting a prescription be mailed or delivered if the pharmacist or pharmacy discloses to the patient before the delivery the fee that will be charged and that the fee may not be reimbursable by the by the health benefit plan issuer or pharmacy benefit manager.
Finally, this bill would specify certain professional standards and scope of practice requirements for health benefit plan issuers or pharmacy benefit managers.
Texas Action is neutral on HB 2817 as it does not appear to affect our liberty principles.
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