Texas § IN.1369.6023 - PHARMACY BENEFIT NETWORK CONTRACT

§ IN.1369.6023. PHARMACY BENEFIT NETWORK CONTRACT

PHARMACY BENEFIT NETWORK CONTRACT: OTHER MODIFICATIONS AND ADDENDUMS. (a) A health benefit plan issuer or pharmacy benefit manager must, not later than the 90th day before the date a proposed modification or addendum to a pharmacy benefit network contract, other than an adverse material change as defined by Section 1369.6022 , is to take effect: (1) post the proposed modification or addendum to the online portal described by Section 1369.6021 ; and (2) provide to the pharmacist or pharmacy notice of the proposed modification or addendum by e-mail, including: (A) a link to the online portal; (B) the National Council for Prescription Drug Programs number or other identifier approved by the commissioner for the pharmacist or pharmacy to which the proposed modification or addendum applies; and (C) a description of the proposed modification or addendum in a manner that allows the pharmacist or pharmacy to compare the proposed modification or addendum to the current contract. (b) If a pharmacist or pharmacy does not respond before the 31st day after the date the pharmacist or pharmacy receives notice of a proposed modification or addendum under Subsection (a), the health benefit plan issuer or pharmacy benefit manager may consider the proposed modification or addendum approved by the pharmacist or pharmacy and the modification or addendum takes effect on the date described by Subsection (a). (c) A pharmacy benefit network contract may not incorporate by reference a document not included in a contract or contract attachment, including a provider manual described by Section 1369.6025 . All financial terms, including reimbursement rates and methodology, must be set forth in the contract. (d) This section does not apply to: (1) a pharmacy benefit network contract: (A) with an unspecified and indefinite duration; (B) with no stated or automatic renewal period or event; and (C) that may only be terminated by notice from one party to the other; or (2) a proposed modification or addendum to a pharmacy benefit network contract that is required by state or federal law or rule. Added by Acts 2025, 89th Leg., R.S., Ch. 183 (S.B. 1236 ), Sec. 4, eff. September 1, 2025.