Bill Text: TX SB1431 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to pharmacy benefit managers contracting with the child health plan program, the Medicaid managed care program, and health plans for certain government employees.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-03-18 - Referred to Health & Human Services [SB1431 Detail]
Download: Texas-2013-SB1431-Introduced.html
83R6204 PMO-D | ||
By: Hinojosa | S.B. No. 1431 |
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relating to pharmacy benefit managers contracting with the child | ||
health plan program, the Medicaid managed care program, and health | ||
plans for certain government employees. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 531, Government Code, is amended by | ||
adding Subchapter Y to read as follows: | ||
SUBCHAPTER Y. PHARMACY BENEFIT MANAGERS | ||
Sec. 531.990. APPLICABILITY. This subchapter applies only | ||
to a Medicaid managed care program under Chapter 533 and the child | ||
health plan program. | ||
Sec. 531.991. TRANSPARENCY IN PHARMACY BENEFIT MANAGEMENT. | ||
(a) In this section, "maximum allowable cost" means a maximum | ||
reimbursement amount for a group of therapeutically and | ||
pharmaceutically equivalent multiple source medications. | ||
(b) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to: | ||
(1) establish: | ||
(A) a method of calculating, updating, and | ||
revising a maximum allowable cost for each covered medication; | ||
(B) a frequency for updating or revising the | ||
maximum allowable cost; and | ||
(C) a maximum allowable cost list that uniformly | ||
serves as a basis for the calculation of reimbursement amounts for | ||
pharmacy claims covered by the child health plan program or | ||
Medicaid managed care program; and | ||
(2) develop and maintain a public Internet website and | ||
post and maintain on the website the information required by | ||
Subdivision (1). | ||
(c) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to provide to the | ||
commission the information required by Subsection (b)(1). On | ||
request, the commission shall provide the information to a | ||
pharmacist or pharmacy. | ||
SECTION 2. Subchapter B, Chapter 1551, Insurance Code, is | ||
amended by adding Section 1551.0671 to read as follows: | ||
Sec. 1551.0671. TRANSPARENCY IN PHARMACY BENEFIT | ||
MANAGEMENT. (a) In this section, "maximum allowable cost" means a | ||
maximum reimbursement amount for a group of therapeutically and | ||
pharmaceutically equivalent multiple source medications. | ||
(b) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to: | ||
(1) establish: | ||
(A) a method of calculating, updating, and | ||
revising a maximum allowable cost for each covered medication; | ||
(B) a frequency for updating or revising the | ||
maximum allowable cost; and | ||
(C) a maximum allowable cost list that uniformly | ||
serves as a basis for the calculation of reimbursement amounts for | ||
pharmacy claims covered by the group benefits program; and | ||
(2) develop and maintain a public Internet website and | ||
post and maintain on the website the information required by | ||
Subdivision (1). | ||
(c) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to provide to the board of | ||
trustees the information required by Subsection (b)(1). On | ||
request, the board of trustees shall provide the information to a | ||
pharmacist or pharmacy. | ||
SECTION 3. Subchapter C, Chapter 1575, Insurance Code, is | ||
amended by adding Section 1575.111 to read as follows: | ||
Sec. 1575.111. TRANSPARENCY IN PHARMACY BENEFIT | ||
MANAGEMENT. (a) In this section, "maximum allowable cost" means a | ||
maximum reimbursement amount for a group of therapeutically and | ||
pharmaceutically equivalent multiple source medications. | ||
(b) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to: | ||
(1) establish: | ||
(A) a method of calculating, updating, and | ||
revising a maximum allowable cost for each covered medication; | ||
(B) a frequency for updating or revising a | ||
maximum allowable cost; and | ||
(C) a maximum allowable cost list that uniformly | ||
serves as a basis for the calculation of reimbursement amounts for | ||
pharmacy claims covered by the group program; and | ||
(2) develop and maintain a public Internet website and | ||
post and maintain on the website the information required by | ||
Subdivision (1). | ||
(c) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to provide to the trustee | ||
the information required by Subsection (b)(1). On request, the | ||
trustee shall provide the information to a pharmacist or pharmacy. | ||
SECTION 4. Subchapter B, Chapter 1579, Insurance Code, is | ||
amended by adding Section 1579.058 to read as follows: | ||
Sec. 1579.058. TRANSPARENCY IN PHARMACY BENEFIT | ||
MANAGEMENT. (a) In this section, "maximum allowable cost" means a | ||
maximum reimbursement amount for a group of therapeutically and | ||
pharmaceutically equivalent multiple source medications. | ||
(b) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to: | ||
(1) establish: | ||
(A) a method of calculating, updating, and | ||
revising a maximum allowable cost for each covered medication; | ||
(B) a frequency for updating or revising a | ||
maximum allowable cost; and | ||
(C) a maximum allowable cost list that uniformly | ||
serves as a basis for the calculation of reimbursement amounts for | ||
pharmacy claims covered by a health coverage plan; and | ||
(2) develop and maintain a public Internet website and | ||
post and maintain on the website the information required by | ||
Subdivision (1). | ||
(c) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to provide to the trustee | ||
the information required by Subsection (b)(1). On request, the | ||
trustee shall provide the information to a pharmacist or pharmacy. | ||
SECTION 5. Subchapter B, Chapter 1601, Insurance Code, is | ||
amended by adding Section 1601.065 to read as follows: | ||
Sec. 1601.065. TRANSPARENCY IN PHARMACY BENEFIT | ||
MANAGEMENT. (a) In this section, "maximum allowable cost" means a | ||
maximum reimbursement amount for a group of therapeutically and | ||
pharmaceutically equivalent multiple source medications. | ||
(b) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to: | ||
(1) establish: | ||
(A) a method of calculating, updating, and | ||
revising the maximum allowable cost for each covered medication; | ||
(B) a frequency for updating or revising a | ||
maximum allowable cost; and | ||
(C) a maximum allowable cost list that uniformly | ||
serves as a basis for the calculation of reimbursement amounts for | ||
pharmacy claims covered by the basic coverage; and | ||
(2) develop and maintain a public Internet website and | ||
post and maintain on the website the information required by | ||
Subdivision (1). | ||
(c) A contract to provide pharmacy benefit manager services | ||
must require the pharmacy benefit manager to provide to the | ||
governing board of the system the information required by | ||
Subsection (b)(1). On request, the system shall provide the | ||
information to a pharmacist or pharmacy. | ||
SECTION 6. Subchapter Y, Chapter 531, Government Code, and | ||
Sections 1551.0671, 1575.111, 1579.058, and 1601.065, Insurance | ||
Code, as added by this Act, apply only to a contract with a pharmacy | ||
benefit manager executed or renewed on or after the effective date | ||
of this Act. | ||
SECTION 7. This Act takes effect September 1, 2013. |