Sec. 1369.553. REDUCTION OF CERTAIN CLAIM PAYMENT AMOUNTS PROHIBITED. (a) A health benefit plan issuer or pharmacy benefit manager may not directly or indirectly reduce the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim through the use of an aggregated effective rate, quality assurance program, other direct or indirect remuneration fee, or otherwise, except in accordance with an audit performed under Subchapter F.
(b) Nothing in this section prohibits a health benefit plan issuer or pharmacy benefit manager from increasing a claim payment amount after adjudication of the claim.
Added by Acts 2021, 87th Leg., R.S., Ch. 142 (H.B. 1763), Sec. 1, eff. September 1, 2021.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle E - Benefits Payable Under Health Coverages
Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services
Subchapter L. Contracts With Pharmacists and Pharmacies
Section 1369.552. Applicability of Subchapter
Section 1369.553. Reduction of Certain Claim Payment Amounts Prohibited
Section 1369.554. Reimbursement of Affiliated and Nonaffiliated Pharmacists and Pharmacies
Section 1369.555. Network Contract Fee Schedule
Section 1369.556. Disclosure of Pharmacy Services Administrative Organization Contract
Section 1369.557. Delivery of Drugs
Section 1369.558. Professional Standards and Scope of Practice Requirements