CHAPTER 1560. DELIVERY OF PRESCRIPTION DRUGS BY MAIL - Texas Statutes

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE H. HEALTH BENEFITS AND OTHER COVERAGES FOR GOVERNMENTAL

EMPLOYEES

CHAPTER 1560. DELIVERY OF PRESCRIPTION DRUGS BY MAIL

Sec. 1560.001. DEFINITIONS. In this chapter:

(1) "Community retail pharmacy" means a pharmacy that is

licensed as a Class A pharmacy under Chapter 560, Occupations

Code.

(2) "Mail order pharmacy" means a pharmacy that is licensed

under Chapter 560, Occupations Code, and that primarily delivers

prescription drugs to an enrollee through the United States

Postal Service or a commercial delivery service.

Added by Acts 2009, 81st Leg., R.S., Ch.

1207, Sec. 5, eff. September 1, 2009.

Sec. 1560.002. APPLICABILITY OF CHAPTER. This chapter applies

only to a health benefit plan that provides benefits for medical

or surgical expenses incurred as a result of a health condition,

accident, or sickness, including an individual, group, blanket,

or franchise insurance policy or insurance agreement, a group

hospital service contract, or an individual or group evidence of

coverage or similar coverage document that is offered or

administered by:

(1) the Teacher Retirement System of Texas under Chapter 1575 or

1579; or

(2) the Employees Retirement System of Texas under Chapter 1551.

Added by Acts 2009, 81st Leg., R.S., Ch.

1207, Sec. 5, eff. September 1, 2009.

Sec. 1560.003. MULTIPLE-MONTH SUPPLY OF PRESCRIPTION DRUG. (a)

In this section, "multiple-month supply" means a supply for 60 or

more days.

(b) Notwithstanding any other law, an issuer of a health benefit

plan that provides pharmacy benefits to enrollees must allow an

enrollee to obtain from a community retail pharmacy a

multiple-month supply of any prescription drug under the same

terms and conditions applicable when the prescription drug is

obtained from a mail order pharmacy, if the community retail

pharmacy agrees to accept reimbursement on exactly the same terms

and conditions that apply to a mail order pharmacy.

(c) This section does not require:

(1) the issuer of a health benefit plan to contract with:

(A) a retail pharmacy that does not agree to accept

reimbursement on exactly the same terms and conditions that apply

to a mail order pharmacy; or

(B) more than one mail order pharmacy; or

(2) a community retail pharmacy to:

(A) provide a multiple-month supply of a prescription drug under

the same terms and conditions applicable when the prescription

drug is obtained from a mail order pharmacy; or

(B) agree to accept reimbursement on exactly the same terms and

conditions that apply to a mail order pharmacy.

Added by Acts 2009, 81st Leg., R.S., Ch.

1207, Sec. 5, eff. September 1, 2009.

Sec. 1560.004. PRESCRIPTION DRUG REIMBURSEMENT RATES. (a) An

issuer of a health benefit plan that provides pharmacy benefits

to enrollees shall reimburse pharmacies participating in the

health plan using prescription drug reimbursement rates, for both

brand name and generic prescription drugs, that are based on a

current and nationally recognized benchmark index that includes

average wholesale price and maximum allowable cost.

(b) Regardless of whether a pharmacy is a mail order pharmacy or

a community retail pharmacy, an issuer of a health benefit plan

shall use the same benchmark index, including the same average

wholesale price, maximum allowable cost, and national

prescription drug codes, to reimburse all pharmacies

participating in the health benefit plan.

Added by Acts 2009, 81st Leg., R.S., Ch.

1207, Sec. 5, eff. September 1, 2009.