Many states throughout the country have enacted various laws aimed at protecting independent pharmacies from improper and predatory practices by pharmacy benefit managers (PBMs). One example of a state with aggressive laws aimed at protecting independent pharmacies is the State of Texas. Specifically, the Texas Insurance Code (Code) includes various provisions that expressly apply to PBMs operating in Texas and require prompt and timely payment of clean claims by PBMs to pharmacies. This provision provides that a PBM must pay the total amount of prescription claims to providers through EFT “not later than the 18th day after the date on which the claim was affirmatively adjudicated.”
The Code also provides for certain penalties if a PBM fails to comply with these provisions including attorney’s fees. The Code states that if a provider is not paid in a timely manner, the provider making the claim will be entitled to “the contracted rate owed on the claim plus a penalty in the amount of the lesser of: (1) 50 percent of the difference between the billed charges, as submitted on the claim, and the contracted rate; or (2) $100,000.” In fact, the penalties can increase for noncompliance up to the lesser of 100 percent of the difference between the billed charges or $200,000. The Code further states that a “provider may recover reasonable attorney’s fees and court costs in an action to recover payment.” These favorable laws offer Texas independent pharmacies experiencing improper delays in payment from PBMs valuable tools to address such conduct by PBMs.
How Frier Levitt Can Help
Frier Levitt has extensive experience working with independent pharmacies throughout the United States, including in the State of Texas, on all aspects of PBM payment disputes and audits as well as various other PBM matters. The attorneys at Frier Levitt include clinicians and experienced litigators, including attorneys licensed in the State of Texas. Frier Levitt’s attorneys are prepared to take all necessary steps to fight on behalf of Texas independent pharmacies against improper PBM practices including by using the various Texas laws that have been enacted to protect its independent pharmacies. If you or your pharmacy have questions or need help with any type of PBM dispute, contact us today to speak to an attorney.
