Legislative Initiatives 

The Alliance has two main legislative priorities for 2019 Texas Legislative Session, which began January 8, 2019.

PBM Reform (SB 2261/HB 2231 by Kolkhorst/Oliverson)
An uneven playing field shortchanges local pharmacists and creates barriers to the physician-patient relationship. Pharmacy Benefit Managers' (PBMs) anticompetitive business practices hinder patients' access to much needed medication and threaten the continued viability of community pharmacy.

Texas pharmacies support legislation that would provide reasonable protections for patients who receive prescription drug benefits through a commercial health plan subject to Texas Department of Insurance oversight similar to other providers in the supply chain.

The proposed legislation would create:

Transparency

  • Provides transparency in prescription drug pricing and ensures contracts adequately describe how reimbursements will be calculated
  • Requires PBMs to disclose information regarding rebates and financial conflicts-of-interest to plan sponsors

Oversight

  • Lowers out-of-pocket costs for patients by ensuring rebates are credited at the point-of-sale, and prohibits PBMs from charging patients more in co-pays or co-insurance than the actual cost of the drug
  • Limits the assessment of hidden fees and unreasonable audit practices that result in higher costs to patients

Protections

  • Provides pharmacies with protections already extended to other providers under the Texas Insurance Code, such as requiring consent of a pharmacy when certain contractual rights are transferred to another party
  • Allows pharmacies access to participate in PBM networks and contracts, and provides contract transparency regarding the various lines of business  administered by a PBM similar to other providers

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Texas Health and Human Services Commission conducted a study which clearly outlines the state can save millions by using a single state-wide fiscal agent. (SB 2262/HB 3388 by Kolkhorst/Sheffield)

Senate Bill 1 (85R) Texas Health and Human Services Commission Rider 60 commissioned a study to quantify potential savings by increasing transparency and accountability in the drug benefit.

The bill implements taxpayer savings from Rider 60 including:
1. Moving to a single, statewide claims processor model in delivering prescription drug benefits to all of Texas' Medicaid and general revenue programs.

2. Reducing or eliminating the Affordable Care Act Health Insurance Providers Fee, risk margin, and administrative services costs weighting down the current capitation.

3. Transitioning prescription drug benefits to a more real-time transparent pricing methodology with a commensurate professional dispensing fee.

4. Providing an opportunity for increasing ability to improve adherence to its Preferred Drug List (PDL), help identify outcomes based pharmacy data, and more efficiently identify outcomes and trends in pharmacy utilization.

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See list of pharmacy supported bills.