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