Independent pharmacies in Texas have significant protections from unfair practices by Pharmacy Benefit Managers (PBMs) in the form of HB 1919 and HB 1763. As previously discussed by Frier Levitt, HB 1763 provides Texas pharmacies with safeguards from improper PBM tactics through
(1) limitations on retroactive claims reductions (including DIR fees);
(2) restrictions/limitations on contract provisions prohibiting pharmacies from mailing;
(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 1919 provides additional safeguards to Texas pharmacies and their patients by limiting PBMs from pressuring or incentivizing patients to use PBM affiliated pharmacies. More specifically, HB 1919 prohibits PBMs from steering patients to affiliated pharmacies through patient-specific advertising, marketing, or promotion. In addition, a PBM may not require a patient to use an affiliated pharmacy as a condition to receive the maximum benefit for a service under the patient’s pharmacy benefit plan. Texas kept its patients’ economic interests in mind by removing the financial downside for choosing their community pharmacy to fill their prescriptions. Thus, patients are free to choose the pharmacy of their choice without having to endure negative financial implications for not choosing a PBM affiliated pharmacy.
HBs 1763 and 1919 protect independent pharmacies from PBM overreach which threaten independent pharmacies’ operations and continued viability. The Texas legislature has enacted laws that if enforced will limit the ability of PBMs to continue to engage in certain improper tactics that have been significant issues for independent pharmacies over the past several years.
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 in addition to federal laws which regulate PBM conduct.
