PBM reform, Texas pharmacy’s top priority for the 86th Legislative Session, took a major step forward on Tuesday, April 30, when the Texas House of Representatives overwhelmingly passed HB 2817 in a 139-3 vote. Now the strongest commercial PBM reform bill ever in Texas moves to the Senate, where it currently awaits a hearing in the Business and Commerce Committee.
The bill by Rep. Eddie Lucio III, chair of the House Insurance Committee, incorporates several provisions from HB 2231 by Rep. Tom Oliverson. Specifically, this legislation:
requires transparency in contracting by making PBMs accurately describe how reimbursements will be calculated in their contracts with pharmacies rather than relying on secret price lists;
prohibits post-adjudication reduction of payments or recoupment of claims, including DIR or GER-like fees;
prohibits PBMs from paying affiliated retail or mail-order pharmacies more than they pay other pharmacies in a network;
allows a pharmacist or pharmacy belonging to a pharmacy services administration organization (PSAO) to receive a copy of applicable contract provisions from health plan or PBM;
provides legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals or complaints against PBMs;
prohibits PBMs from including contract language that prohibits pharmacies from delivering prescriptions to patients; and
prevents PBMs from requiring pharmacies to obtain additional accreditations and certifications beyond what is required by the Texas State Board of Pharmacy.
“PBM business practices hinder patients’ access to much-needed medication and threaten the continued viability of community pharmacy, while artificially driving up the costs of prescription drugs for consumers,” said Texas Pharmacy Association CEO Debbie Garza, R.Ph. “We appreciate Chairman Lucio’s leadership and skillful navigation to protect patients and pharmacies, as well as Rep. Oliverson’s tireless dedication to this issue.”
Administration
says... Posted Wednesday, May 8, 2019
Call or write to Senators who serve on the Senate Business and Commerce Committee (find their names and contact information here: https://senate.texas.gov/cmte.php?c=510). Tell them that you are a pharmacist and ask them to request a hearing for House Bill 2817 in the Business and Commerce Committee. An uneven playing field shortchanges local pharmacists and creates barriers to the physician-patient relationship. Pharmacy Benefit Manager (PBM) business practices hinder patients’ access to much-needed medication and threaten the continued viability of community pharmacy, while artificially driving up the costs of prescription drugs for consumers. Texas pharmacists support HB 2817, by Chairman Eddie Lucio III, which would require reasonable transparency on the part of PBMs and provide protections for patients and pharmacies. It is critical that the Texas Legislature enact PBM reform to protect patients and pharmacies in our state.
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