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A BILL TO BE ENTITLED
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AN ACT
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relating to pharmacy benefit managers contracting with the child |
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health plan program, the Medicaid managed care program, and health |
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plans for certain government employees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 531, Government Code, is amended by |
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adding Subchapter Y to read as follows: |
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SUBCHAPTER Y. PHARMACY BENEFIT MANAGERS |
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Sec. 531.990. APPLICABILITY. This subchapter applies only |
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to a Medicaid managed care program under Chapter 533 and the child |
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health plan program. |
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Sec. 531.991. TRANSPARENCY IN PHARMACY BENEFIT MANAGEMENT. |
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(a) In this section, "maximum allowable cost" means a maximum |
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reimbursement amount for a group of therapeutically and |
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pharmaceutically equivalent multiple source medications. |
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(b) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to: |
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(1) establish: |
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(A) a method of calculating, updating, and |
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revising a maximum allowable cost for each covered medication; |
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(B) a frequency for updating or revising the |
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maximum allowable cost; and |
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(C) a maximum allowable cost list that uniformly |
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serves as a basis for the calculation of reimbursement amounts for |
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pharmacy claims covered by the child health plan program or |
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Medicaid managed care program; and |
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(2) develop and maintain a public Internet website and |
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post and maintain on the website the information required by |
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Subdivision (1). |
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(c) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to provide to the |
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commission the information required by Subsection (b)(1). On |
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request, the commission shall provide the information to a |
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pharmacist or pharmacy. |
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SECTION 2. Subchapter B, Chapter 1551, Insurance Code, is |
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amended by adding Section 1551.0671 to read as follows: |
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Sec. 1551.0671. TRANSPARENCY IN PHARMACY BENEFIT |
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MANAGEMENT. (a) In this section, "maximum allowable cost" means a |
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maximum reimbursement amount for a group of therapeutically and |
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pharmaceutically equivalent multiple source medications. |
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|
(b) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to: |
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(1) establish: |
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|
(A) a method of calculating, updating, and |
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|
revising a maximum allowable cost for each covered medication; |
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(B) a frequency for updating or revising the |
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maximum allowable cost; and |
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(C) a maximum allowable cost list that uniformly |
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serves as a basis for the calculation of reimbursement amounts for |
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pharmacy claims covered by the group benefits program; and |
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(2) develop and maintain a public Internet website and |
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post and maintain on the website the information required by |
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Subdivision (1). |
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(c) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to provide to the board of |
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trustees the information required by Subsection (b)(1). On |
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request, the board of trustees shall provide the information to a |
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pharmacist or pharmacy. |
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SECTION 3. Subchapter C, Chapter 1575, Insurance Code, is |
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amended by adding Section 1575.111 to read as follows: |
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Sec. 1575.111. TRANSPARENCY IN PHARMACY BENEFIT |
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MANAGEMENT. (a) In this section, "maximum allowable cost" means a |
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maximum reimbursement amount for a group of therapeutically and |
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pharmaceutically equivalent multiple source medications. |
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|
(b) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to: |
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(1) establish: |
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|
(A) a method of calculating, updating, and |
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|
revising a maximum allowable cost for each covered medication; |
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(B) a frequency for updating or revising a |
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|
maximum allowable cost; and |
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(C) a maximum allowable cost list that uniformly |
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serves as a basis for the calculation of reimbursement amounts for |
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pharmacy claims covered by the group program; and |
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(2) develop and maintain a public Internet website and |
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post and maintain on the website the information required by |
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Subdivision (1). |
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(c) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to provide to the trustee |
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the information required by Subsection (b)(1). On request, the |
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trustee shall provide the information to a pharmacist or pharmacy. |
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SECTION 4. Subchapter B, Chapter 1579, Insurance Code, is |
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amended by adding Section 1579.058 to read as follows: |
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Sec. 1579.058. TRANSPARENCY IN PHARMACY BENEFIT |
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MANAGEMENT. (a) In this section, "maximum allowable cost" means a |
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maximum reimbursement amount for a group of therapeutically and |
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pharmaceutically equivalent multiple source medications. |
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|
(b) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to: |
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(1) establish: |
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(A) a method of calculating, updating, and |
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|
revising a maximum allowable cost for each covered medication; |
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(B) a frequency for updating or revising a |
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|
maximum allowable cost; and |
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(C) a maximum allowable cost list that uniformly |
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serves as a basis for the calculation of reimbursement amounts for |
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pharmacy claims covered by a health coverage plan; and |
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(2) develop and maintain a public Internet website and |
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post and maintain on the website the information required by |
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Subdivision (1). |
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(c) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to provide to the trustee |
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the information required by Subsection (b)(1). On request, the |
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trustee shall provide the information to a pharmacist or pharmacy. |
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SECTION 5. Subchapter B, Chapter 1601, Insurance Code, is |
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amended by adding Section 1601.065 to read as follows: |
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Sec. 1601.065. TRANSPARENCY IN PHARMACY BENEFIT |
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MANAGEMENT. (a) In this section, "maximum allowable cost" means a |
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maximum reimbursement amount for a group of therapeutically and |
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pharmaceutically equivalent multiple source medications. |
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(b) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to: |
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(1) establish: |
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(A) a method of calculating, updating, and |
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revising the maximum allowable cost for each covered medication; |
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(B) a frequency for updating or revising a |
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maximum allowable cost; and |
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(C) a maximum allowable cost list that uniformly |
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serves as a basis for the calculation of reimbursement amounts for |
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pharmacy claims covered by the basic coverage; and |
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(2) develop and maintain a public Internet website and |
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post and maintain on the website the information required by |
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Subdivision (1). |
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(c) A contract to provide pharmacy benefit manager services |
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must require the pharmacy benefit manager to provide to the |
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governing board of the system the information required by |
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Subsection (b)(1). On request, the system shall provide the |
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information to a pharmacist or pharmacy. |
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SECTION 6. Subchapter Y, Chapter 531, Government Code, and |
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Sections 1551.0671, 1575.111, 1579.058, and 1601.065, Insurance |
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Code, as added by this Act, apply only to a contract with a pharmacy |
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benefit manager executed or renewed on or after the effective date |
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of this Act. |
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SECTION 7. This Act takes effect September 1, 2013. |