84R7002 PMO-D
 
  By: Eltife S.B. No. 1176
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the authority and rights of pharmacy services
  administrative organizations to conduct the business of
  independent pharmacies with respect to certain pharmacy benefits.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter I, Chapter 843, Insurance Code, is
  amended by adding Section 843.324 to read as follows:
         Sec. 843.324.  PHARMACY SERVICES ADMINISTRATIVE
  ORGANIZATIONS. (a) In this section:
               (1)  "Independent pharmacy" means a pharmacy that is
  under common ownership with not more than two other pharmacies.
               (2)  "Pharmacy benefit manager" means a person, other
  than a pharmacist, pharmacy, or pharmacy services administrative
  organization, who acts as an administrator in connection with
  pharmacy benefits.
               (3)  "Pharmacy services administrative organization"
  means an entity that contracts with an independent pharmacy to
  conduct on behalf of the pharmacy the pharmacy's business with a
  third-party payor, including a pharmacy benefit manager, in
  connection with pharmacy benefits and to assist the pharmacy by
  providing administrative services, including negotiating,
  executing, and administering a contract with a third-party payor
  and communicating with the third-party payor in connection with a
  contract or pharmacy benefits.
         (b)  This section applies to a Medicaid managed care program
  and a managed care organization that contracts with the Health and
  Human Services Commission to provide services under Chapter 533,
  Government Code.
         (c)  This section does not apply with respect to pharmacy
  benefits under a self-insured, self-funded, or other employee
  welfare benefit plan that is exempt from state regulation under the
  Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
  1001 et seq.).
         (d)  Subject to Subsection (e), a pharmacy services
  administrative organization designated and authorized by an
  independent pharmacy as the pharmacy's agent and vested with actual
  authority may conduct the pharmacy's business with a pharmacy
  benefit manager in connection with pharmacy benefits provided under
  a health maintenance organization plan and administered by a
  pharmacy benefit manager.
         (e)  Before a pharmacy services administrative organization
  may act on behalf of the independent pharmacy as described by
  Subsection (d), the pharmacy must provide written notice to the
  pharmacy benefit manager that the organization has the authority to
  conduct the pharmacy's business with the pharmacy benefit manager
  to the extent provided in the notice. The notice must detail the
  specific nature and scope of the authority granted to the
  organization with respect to the pharmacy's business with the
  pharmacy benefit manager.
         (f)  A pharmacy benefit manager that receives a notice under
  Subsection (e) shall recognize the authority of the pharmacy
  services administrative organization to conduct the pharmacy's
  business with the pharmacy benefit manager to the extent provided
  in the notice. A pharmacy benefit manager may not refuse to deal
  with the organization to the extent of the authority detailed in the
  notice, including by refusing to:
               (1)  enter into a contract with the organization acting
  on behalf of the independent pharmacy on terms agreed to by the
  pharmacy benefit manager and organization; or
               (2)  communicate with the organization about any matter
  relevant to the pharmacy or pharmacy benefits, including contract
  provisions, maximum allowable cost lists, and reimbursement price
  appeals.
         (g)  A pharmacy benefit manager may not require an
  independent pharmacy acting through a pharmacy services
  administrative organization under this section to participate as a
  network provider or preferred provider under a particular health
  benefit plan as a condition of participating as a network provider
  or preferred provider under another health benefit plan.
         (h)  A pharmacy services administrative organization has the
  same rights and obligations under this chapter as the independent
  pharmacy on behalf of which the organization acts with respect to
  pharmacy benefits provided under a health maintenance organization
  plan and administered by a pharmacy benefit manager, to the extent
  of the organization's authority to act with respect to those
  benefits.
         SECTION 2.  Subchapter B, Chapter 1301, Insurance Code, is
  amended by adding Section 1301.070 to read as follows:
         Sec. 1301.070.  PHARMACY SERVICES ADMINISTRATIVE
  ORGANIZATIONS. (a) In this section:
               (1)  "Independent pharmacy" means a pharmacy that is
  under common ownership with not more than two other pharmacies.
               (2)  "Pharmacy benefit manager" means a person, other
  than a pharmacist, pharmacy, or pharmacy services administrative
  organization, who acts as an administrator in connection with
  pharmacy benefits.
               (3)  "Pharmacy services administrative organization"
  means an entity that contracts with an independent pharmacy to
  conduct on behalf of the pharmacy the pharmacy's business with a
  third-party payor, including a pharmacy benefit manager, in
  connection with pharmacy benefits and to assist the pharmacy by
  providing administrative services, including negotiating,
  executing, and administering a contract with a third-party payor
  and communicating with the third-party payor in connection with a
  contract or pharmacy benefits.
         (b)  Notwithstanding Section 1301.0041, this section applies
  to a Medicaid managed care program and a managed care organization
  that contracts with the Health and Human Services Commission to
  provide services under Chapter 533, Government Code.
         (c)  This section does not apply with respect to pharmacy
  benefits under a self-insured, self-funded, or other employee
  welfare benefit plan that is exempt from state regulation under the
  Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
  1001 et seq.).
         (d)  Subject to Subsection (e), a pharmacy services
  administrative organization designated and authorized by an
  independent pharmacy as the pharmacy's agent and vested with actual
  authority may conduct the pharmacy's business with a pharmacy
  benefit manager in connection with pharmacy benefits provided under
  a preferred provider benefit plan and administered by a pharmacy
  benefit manager.
         (e)  Before a pharmacy services administrative organization
  may act on behalf of the independent pharmacy as described by
  Subsection (d), the pharmacy must provide written notice to the
  pharmacy benefit manager that the organization has the authority to
  conduct the pharmacy's business with the pharmacy benefit manager
  to the extent provided in the notice. The notice must detail the
  specific nature and scope of the authority granted to the
  organization with respect to the pharmacy's business with the
  pharmacy benefit manager.
         (f)  A pharmacy benefit manager that receives a notice under
  Subsection (e) shall recognize the authority of the pharmacy
  services administrative organization to conduct the pharmacy's
  business with the pharmacy benefit manager to the extent provided
  in the notice. A pharmacy benefit manager may not refuse to deal
  with the organization to the extent of the authority detailed in the
  notice, including by refusing to:
               (1)  enter into a contract with the organization acting
  on behalf of the independent pharmacy on terms agreed to by the
  pharmacy benefit manager and organization; or
               (2)  communicate with the organization about any matter
  relevant to the pharmacy or pharmacy benefits, including contract
  provisions, maximum allowable cost lists, and reimbursement price
  appeals.
         (g)  A pharmacy benefit manager may not require an
  independent pharmacy acting through a pharmacy services
  administrative organization under this section to participate as a
  network provider or preferred provider under a particular health
  benefit plan as a condition of participating as a network provider
  or preferred provider under another health benefit plan.
         (h)  A pharmacy services administrative organization has the
  same rights and obligations under this chapter as the independent
  pharmacy on behalf of which the organization acts with respect to
  pharmacy benefits provided under a preferred provider benefit plan
  and administered by a pharmacy benefit manager, to the extent of the
  organization's authority to act with respect to those benefits.
         SECTION 3.  This Act applies only to benefits provided under
  a health benefit plan that is delivered, issued for delivery, or
  renewed on or after the effective date of this Act. Benefits
  provided under a health benefit plan delivered, issued for
  delivery, or renewed before the effective date of this Act are
  governed by the law as it existed immediately before the effective
  date of this Act, and that law is continued in effect for that
  purpose.
         SECTION 4.  This Act takes effect September 1, 2015.