State Codes and Statutes
Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1560-delivery-of-prescription-drugs-by-mail
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.
State Codes and Statutes
Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1560-delivery-of-prescription-drugs-by-mail
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.
State Codes and Statutes
Statutes >
Texas >
Insurance-code >
Title-8-health-insurance-and-other-health-coverages >
Chapter-1560-delivery-of-prescription-drugs-by-mail 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.
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