Texas Takes the Lead in Cracking Down on Claims Adjudication Fees by PBMs

As of September 2015, Texas law explicitly prohibits health benefit plan issuers and Pharmacy Benefit Managers (PBMs) from directly or indirectly charging or otherwise holding a pharmacy or pharmacist responsible for fees related to the claim adjudication process. This means that PBMs may not charge fees for the adjudication of a pharmacy benefit claim, the processing or transmission of such a claim, the development or management of a claim processing or adjudication network, or participation in a claim processing or adjudication network. If you are a pharmacy or pharmacist, you should always check your claims data to ensure PBMs are not charging you fees for the adjudication of claims. If such fees have been or are currently being assessed by PBMs, contact Frier Levitt and we can help you to assert your rights in dealing with unauthorized claims practices.