What HB 1293 Does for Medicaid Patients & Pharmacies
HB 1293 would require Managed Care PBMs to pay Texas Medicaid pharmacies for product (medication) cost and dispensing fee at the same levels at which the state pays in the FFS Program (NADAC + $10.12). The bill also would require Texas Health and Human Services Commission (HHSC) to regularly study the retail cost of dispensing drugs in Texas and afterward adjust the Medicaid dispensing fee based on study results.
Other provisions require PBMs to update "drug reimbursement price information" for the Texas Vendor Drug Program at least every seven days and to set up and maintain a system that allows network pharmacies to appeal the reimbursement price of any drug.
The bill would make reimbursement to Medicaid pharmacies more transparent through use of the easily accessed and verified NADAC pricing standard for medications instead of murky PBM formulas that are based on based on highly variable AWP pricing.
Michael Wright, vice president of government affairs, said the growing reimbursement gap is a direct threat to patient welfare in the Texas Medicaid Program.
"This bill is about protecting the adequacy of the Medicaid pharmacy network and Medicaid patients' access to pharmacy care," Wright said. "As providers of vital vaccinations, COVID testing and other services, they are a critical part of the healthcare infrastructure in Texas. This especially true in rural and low-income areas, where they may be the only accessible provider."
Full Support by Texas Pharmacy Groups
American Pharmacies is working cooperatively with Texas Pharmacy Association, National Association of Chain Drug Stores and other groups in support of HB 1293.
"We are deeply indebted to Rep. Rose for her bill and look forward to working with other Texas pharmacy groups to get it passed," Wright said.
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