A bipartisan piece of legislation aimed at regulating pharmacy benefit managers (PBMs) in the State of Texas unanimously passed the House and Senate in Texas. Specifically, House Bill (HB) 1763 previously passed the Texas House by a vote of 147-0 and subsequently passed in the Texas Senate by a vote of 30-0. HB 1763 will now be presented to Governor Greg Abbott (where it can be signed, vetoed, or become law without signature after 10 days).
HB 1763 is an important piece of legislation which reflects a deep understanding by the Texas Legislature of the various challenges facing independent pharmacies (and tactics used by PBMs) in Texas. A few highlights of HB 1763 include (1) restrictions on retroactive claims reductions (including DIR fees); (2) restrictions on contract provisions prohibiting pharmacies from mailing up to 25% of its total claims; (3) express prohibitions on retaliation by a PBM against pharmacies for invoking their legal rights against PBMs and (4) prohibitions on PBMs reimbursing affiliated pharmacies more than the amount reimbursed to nonaffiliated pharmacies for the same pharmacy services.
HB 1763 is an important piece of legislation and reflects the growing concerns surrounding PBM conduct at the state level, but also an ever-increasing response to these concerns by state legislatures throughout the United States. Texas joins several other states that have recently enacted new legislation aimed at reasonable regulation of PBMs.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States in challenging PBM audits, network access, reimbursement practices and has extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including Texas’ current PBM laws as well as the additional protections provided under SB 1763 if enacted.
