Bill Amendment: TX HB1919 | 2021-2022 | 87th Legislature

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: Relating to prohibited practices for certain health benefit plan issuers and pharmacy benefit managers.

Status: 2021-06-18 - Effective on 9/1/21 [HB1919 Detail]

Download: Texas-2021-HB1919-House_Amendment_H_2_2-Harris.html

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Amend CSHB 1919 (house committee printing) by adding the following appropriately numbered SECTIONS to the bill and renumbering subsequent SECTIONS of the bill accordingly:

SECTION ____.  Subchapter B, Chapter 531, Government Code, is amended by adding Section 531.0695 to read as follows:

Sec. 531.0695.  REQUIRED FEE SCHEDULE FOR CERTAIN PHARMACY BENEFITS PROVIDED UNDER MEDICAID OR CHILD HEALTH PLAN PROGRAM. (a) In this section, "pharmacy benefit manager" has the meaning assigned by Section 4151.151, Insurance Code.

(b)  A contract between a pharmacy benefit manager and a managed care organization that contracts with the commission to provide pharmacy benefits under Medicaid or the child health plan program must contain a requirement that the pharmacy benefit manager have a fee schedule that applies to each pharmacy or pharmacist with which the pharmacy benefit manager contracts. The contract between the pharmacy benefit manager and the pharmacy or pharmacist must refer to the fee schedule and the pharmacy benefit manager shall provide the fee schedule:

(1)  in the contract; or

(2)  separately in an easy-to-access, electronic spreadsheet format and, on request by the pharmacy or pharmacist, in writing.

(c)  A fee schedule provided under Subsection (b) must describe:

(1)  specific pharmacy benefits that the pharmacy or pharmacist may deliver and the amount of the corresponding reimbursement for those benefits;

(2)  the methodology used to calculate the reimbursement for specific pharmacy benefits; or

(3)  another reasonable method that a pharmacy or pharmacist may use to ascertain the corresponding reimbursement amount for a specific pharmacy benefit.

SECTION ____.  Section 531.0695, Government Code, as added by this Act, applies only to a contract entered into or renewed on or after the effective date of this Act. A contract entered into or renewed before the effective date of this Act is 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 ____.  If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.