Texas Legislature Passes PBM Reform; Bill Headed to Governor

In a significant and exciting win for Texas pharmacy, the Texas Senate today unanimously passed important pharmacy benefit manager (PBM) reform legislation that will now be sent to Governor Greg Abbott's desk. House Bill 1763 by Rep. Tom Oliverson, sponsored by Sen. Bryan Hughes, received a 30–0 vote in the Senate and already passed the Texas House on April 27 by a vote of 147–0. The governor has 10 days to sign the bill, veto it, or allow it to become law without a signature.

The Texas Pharmacy Association worked closely with legislators to pass a strong bill that protects pharmacists and their patients. As originally filed, HB 1763 included concessions to the PBMs that actually had the potential to hurt pharmacy. At the request of TPA, Rep. Eddie Lucio III offered important amendments on the House floor to strengthen the bill and eliminate PBM loopholes. Senator Hughes praised the Lucio amendment today on the Senate floor, saying that it made for "a much stronger and fairer bill.” When the bill was stalled in the legislature, TPA encouraged Sen. Lois Kolkhorst to introduce Senate Bill 2195, a similar PBM reform bill that in early May was unanimously passed by the Senate Health and Human Services Committee and by the full Senate. Sen. Kolkhorst's passion and perseverance breathed life into this issue and revived interest in HB 1763.

How HB 1763 Will Help Texas Pharmacists

HB 1763 amends the Texas insurance code to protect patients who receive prescription drug benefits through a commercial health plan subject to Texas Department of Insurance (TDI) oversight, similar to others in the supply chain. Specifically, it:

• Prohibits PBM clawbacks that reduce the amount paid to a pharmacy for a prescription weeks or months after a prescription is filled.
• Ensures patient choice by allowing local pharmacies to mail and deliver prescriptions if requested by the patient.
• Prevents self-dealing by prohibiting PBMs from steering patients to PBM-owned specialty pharmacies by requiring accreditations or certifications above those required by state and federal law.
• Prohibits PBMs from paying affiliated retail or mail-order pharmacies more than they pay other pharmacies in a network.
• Allows pharmacists access to their PSAO contract.
• Provides legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals or complaints against PBMs.