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TexasSB 123689th Legislature Regular SessionSenate

Relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers.

Sponsored By: Cole Hefner, Bryan Hughes (Republican), Jared Patterson

Signed by Governor

Electronic Information SystemsHealth Care ProvidersInsurance--Health & AccidentPHARMACIES & PHARMACISTSPHARMACY BENEFIT MANAGERSINSURANCE, COMMISSIONER OF

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 5 benefits, 0 costs, 0 mixed.

Clearer contracts before pharmacies pay fees

For contracts made or renewed beginning September 1, 2025, insurers and pharmacy benefit managers must provide pharmacies secure online access to contracts, addenda, and provider manuals, including updates. Contracts must include referenced documents as part of the contract or an attachment, and state all financial terms, including payment rates and calculation methods. A separate fee schedule must list service payments, use a method based on a published schedule, or otherwise make payment amounts clear. Contracts must state that Texas Insurance Code Chapter 1369 and the insurance commissioner's related rules apply. No contract-related fee, including an application or participation fee, can be charged before the full proposed contract identifies the network and discloses applicable financial terms.

Limits on health plan group numbers

The group-number rule applies to covered Texas health plans delivered, issued for delivery, or renewed beginning January 1, 2026. A covered plan's identification-card group number can be assigned only to people enrolled in plans covered by this law. Plans already in force remain under prior law until the new rule applies. This rule does not change household eligibility, benefits, or payment amounts.

Pharmacies choose which networks to join

For contracts made or renewed beginning September 1, 2025, insurers and pharmacy benefit managers cannot force pharmacies or pharmacists to join a network. They cannot make joining one network depend on joining another. They also cannot penalize pharmacies or pharmacists for refusing to join. These rules protect pharmacy choice, not a household's right to use any pharmacy.

Pharmacies gain control over contract changes

For contracts made or renewed beginning September 1, 2025, adverse material changes during the contract term require mutual agreement and the pharmacy's written approval. They cannot start before the 120th day after approval. A clear notice must let pharmacies refuse without changing existing terms or participation in another network; without it, an agreed change is void. Other changes require portal posting and email notice at least 90 days ahead, with a portal link, applicable pharmacy identifier, and description showing what changes. Silence by the 31st day after notice can count as approval for those other changes. These rules exclude changes required by state or federal law or rule, and indefinite contracts with no stated or automatic renewal period or event that end only by one party notifying the other.

Stronger payment protections for Texas pharmacies

For contracts made or renewed beginning September 1, 2025, Texas law generally bars insurers and pharmacy benefit managers from reducing claims already approved for payment. They can recover drug costs and dispensing fees for fraud, duplicate payments, or substantive errors—not clerical or recordkeeping errors—that caused a wrong drug or dose. For clerical errors causing overpayments, they can recover only the dispensing fee, not the drug cost. They cannot use results from sampled claims to calculate recovery amounts across other claims. These protections apply to pharmacy payments, not household benefit amounts.

Sponsors & Cosponsors

Sponsors

  • Cole Hefner

    House

  • Bryan Hughes

    Republican • Senate

  • Jared Patterson

    House

Cosponsors

  • César Blanco

    Democratic • Senate

  • Kevin Sparks

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 298 • No: 0

House vote • 5/13/2025

Record vote

Yes: 140 • No: 0

House vote • 5/12/2025

Record vote

Yes: 142 • No: 0

Senate vote • 4/24/2025

Record vote

Yes: 0 • No: 0

Senate vote • 4/24/2025

Record vote

Yes: 0 • No: 0

House vote • Unknown

Committee vote: Insurance

Yes: 7 • No: 0

Senate vote • Unknown

Committee vote: Health & Human Services

Yes: 9 • No: 0

Actions Timeline

  1. Effective on 9/1/25

    5/27/2025House

  2. Signed by the Governor

    5/27/2025House

  3. Sent to the Governor

    5/15/2025House

  4. Signed in the House

    5/15/2025House

  5. Signed in the Senate

    5/15/2025Senate

  6. Reported enrolled

    5/14/2025Senate

  7. House passage reported

    5/14/2025Senate

  8. Statement(s) of vote recorded in Journal

    5/13/2025House

  9. Record vote (RV#2322)

    5/13/2025House

  10. Passed

    5/13/2025House

  11. Read 3rd time

    5/13/2025House

  12. Statement(s) of vote recorded in Journal

    5/12/2025House

  13. Record vote (RV#2168)

    5/12/2025House

  14. Passed to 3rd reading

    5/12/2025House

  15. Read 2nd time

    5/12/2025House

  16. Laid out in lieu of companion (CSHB 3317)

    5/12/2025House

  17. Committee report sent to Calendars

    5/8/2025House

  18. Committee report distributed

    5/7/2025House

  19. Comte report filed with Committee Coordinator

    5/7/2025House

  20. Reported favorably w/o amendment(s)

    5/7/2025House

  21. Considered in public hearing

    5/7/2025House

  22. Referred to Insurance

    4/28/2025House

  23. Read first time

    4/28/2025House

  24. Received from the Senate

    4/25/2025House

  25. Reported engrossed

    4/24/2025Senate

Bill Text

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