Texas Members: If you’ve paid credentialing fees, you shouldn’t have!
If you have paid credentialing fees, make sure you file a complaint with the Texas Department of Insurance (TDI) to receive a refund. TPBC’s SB 94 broke major new ground for Texas retail pharmacy with a ban against PBM-assessed transaction fees. The law prohibits fees for network management services, inclusion in a network, services related to the adjudication of a claim, services for processing a claim, services related to transmitting a claim, or for developing a claims processing and adjudication network. It also gives the Texas Dept. of Insurance stronger enforcement capabilities.
Complaint Portal
Texas Task Force Recommends Pharmacy Reimbursement Floor as Part of Expansive Improvements to State-Sponsored Pharmacy Benefits.
In a comprehensive report, the Texas Pharmaceutical Initiative (TPI) Board outlined numerous opportunities to reduce costs, maintain access, and increase efficiency.
One improvement is the “[c]reating minimum pharmacy reimbursement requirements [e.g., National Average Drug Acquisition Cost (NADAC) informed by Texas-specific survey]”. If its recommendations are fully implemented, the TPI Board anticipates savings of $700 million.
Texas state-sponsored plans include over 7 million beneficiaries of the Teacher Retirement System, Employees Retirement System, public higher education systems, and Medicaid and CHIP programs. These programs oversee $5 billion in annual drug spend. The TPI Board anticipates savings of hundreds of millions of dollars by implementing its recommendations. The TPI Board’s report, which was delivered to the Governor and Legislature, can be found here.
| 
