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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement rates paid to certain pharmacies in |
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connection with health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1560.004, Insurance Code, is amended to |
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read as follows: |
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Sec. 1560.004. PRESCRIPTION DRUG REIMBURSEMENT RATES. (a) |
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Except as provided by Subsection (c), an [An] issuer of a health |
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benefit plan that provides pharmacy benefits to enrollees shall |
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reimburse pharmacies participating in the health plan using |
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prescription drug reimbursement rates, for both brand name and |
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generic prescription drugs, that are based on a current and |
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nationally recognized benchmark index that includes average |
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wholesale price and maximum allowable cost. |
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(b) Except as provided by Subsection (c), regardless |
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[Regardless] of whether a pharmacy is a mail order pharmacy or a |
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community retail pharmacy, an issuer of a health benefit plan shall |
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use the same benchmark index, including the same average wholesale |
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price, maximum allowable cost, and national prescription drug |
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codes, to reimburse all pharmacies participating in the health |
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benefit plan. |
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(c) An issuer of a health benefit plan shall incorporate |
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into the calculation under Subsection (b) any monetary or |
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nonmonetary benefit that a mail order pharmacy receives and that a |
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community retail pharmacy does not receive in connection with |
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providing a prescription drug to enrollees. |
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SECTION 2. Section 1560.004, Insurance Code, as amended by |
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this Act, applies only to a health benefit plan provided under |
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Chapter 1551, 1575, or 1579, Insurance Code, beginning with the |
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2014-2015 plan year. A plan year before 2014-2015 is governed by |
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the law as it existed immediately before September 1, 2014, and that |
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law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2013. |