Transparency of Pharmacy Benefits

The Texas Department of Insurance adopted amendments to 28 Tex. Administrative Code Chapter 21, Subchapter V (Pharmacy Benefits) to implement HB 1624, which requires greater transparency of pharmacy and formulary information under health benefit plan coverage. These rules do not apply to a pharmacy benefit manager (PBM) for a self-funded employee welfare benefit plan exempt from state regulation under ERISA.

In part, a new provision was added requiring issuers of individual, small group and large group health benefit plans to post on their website formulary information, and make the information available through a toll-free telephone number. In addition, the issuer must provide a paper copy of the formulary to a current or prospective enrollee upon request. The effective date is Aug. 18, 2016.

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