Sec. 1369.555. NETWORK CONTRACT FEE SCHEDULE. A pharmacy benefit network contract must specify or reference a separate fee schedule. Unless otherwise available in the contract, the fee schedule must be provided electronically in an easily accessible and complete spreadsheet format and, on request, in writing to each contracted pharmacist and pharmacy. The fee schedule must describe:
(1) specific services or procedures that the pharmacist or pharmacy may deliver and the amount of the corresponding payment;
(2) a methodology for calculating the amount of the payment based on a published fee schedule; or
(3) any other reasonable manner that provides an ascertainable amount for payment for services.
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