Texas SB1354 sets minimum reimbursement rules for pharmacists and pharmacies under health benefit plans.

Texas SB1354 amends the Insurance Code to establish minimum reimbursement rules for pharmacists and pharmacies under health benefit plans. The bill prohibits pharmacy benefit managers from reimbursing pharmacists or pharmacies less than the actual cost for prescription drugs or devices. It also requires pharmacy benefit managers to provide reimbursement procedures and a standard appeal form for pharmacists and pharmacies to challenge reimbursements. If a pharmacist or pharmacy prevails in an appeal, the pharmacy benefit manager must adjust the reimbursement and cover transaction fees.

Texas SB1354 sets minimum reimbursement rules for pharmacists and pharmacies under health benefit plans.

Texas SB1354 amends the Insurance Code to establish minimum reimbursement rules for pharmacists and pharmacies under health benefit plans. The bill prohibits pharmacy benefit managers from reimbursing pharmacists or pharmacies less than the actual cost for prescription drugs or devices. It also requires pharmacy benefit managers to provide reimbursement procedures and a standard appeal form for pharmacists and pharmacies to challenge reimbursements. If a pharmacist or pharmacy prevails in an appeal, the pharmacy benefit manager must adjust the reimbursement and cover transaction fees.