(a) A pharmacy benefits manager shall provide:(1) (A) A reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs for a health benefit plan that shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence.(B) A mail-order pharmacy shall not be included in the calculations determining pharmacy benefits manager network adequacy; and(2) A pharmacy benefits manager network adequacy report describing the pharmacy benefits manager network and the pharmacy benefits manager network's accessibility in this state in the time and manner required by rule issued by the State Insurance Department.
(1) (A) A reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs for a health benefit plan that shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence.(B) A mail-order pharmacy shall not be included in the calculations determining pharmacy benefits manager network adequacy; and
(A) A reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs for a health benefit plan that shall provide for convenient patient access to pharmacies within a reasonable distance from a patient's residence.
(B) A mail-order pharmacy shall not be included in the calculations determining pharmacy benefits manager network adequacy; and
(2) A pharmacy benefits manager network adequacy report describing the pharmacy benefits manager network and the pharmacy benefits manager network's accessibility in this state in the time and manner required by rule issued by the State Insurance Department.
(b) (1) The Insurance Commissioner may examine the books and records of a pharmacy benefits manager as necessary to determine:(A) The aggregate amount of rebates received by a pharmacy benefits manager;(B) The aggregate amount of rebates distributed by a pharmacy benefits manager to an appropriate healthcare payor; and(C) The aggregate amount of rebates passed on to an enrollee of each healthcare payor at the point of sale that reduced the enrollee's applicable deductible, copayment, coinsurance, or other cost-sharing amount.(2) The commissioner may examine the books and records of a pharmacy benefits manager as necessary to determine:(A) The individual and aggregate amount paid by a healthcare payor to the pharmacy benefits manager for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services; and(B) The individual and aggregate amount a pharmacy benefits manager paid for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services.
(1) The Insurance Commissioner may examine the books and records of a pharmacy benefits manager as necessary to determine:(A) The aggregate amount of rebates received by a pharmacy benefits manager;(B) The aggregate amount of rebates distributed by a pharmacy benefits manager to an appropriate healthcare payor; and(C) The aggregate amount of rebates passed on to an enrollee of each healthcare payor at the point of sale that reduced the enrollee's applicable deductible, copayment, coinsurance, or other cost-sharing amount.
(A) The aggregate amount of rebates received by a pharmacy benefits manager;
(B) The aggregate amount of rebates distributed by a pharmacy benefits manager to an appropriate healthcare payor; and
(C) The aggregate amount of rebates passed on to an enrollee of each healthcare payor at the point of sale that reduced the enrollee's applicable deductible, copayment, coinsurance, or other cost-sharing amount.
(2) The commissioner may examine the books and records of a pharmacy benefits manager as necessary to determine:(A) The individual and aggregate amount paid by a healthcare payor to the pharmacy benefits manager for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services; and(B) The individual and aggregate amount a pharmacy benefits manager paid for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services.
(A) The individual and aggregate amount paid by a healthcare payor to the pharmacy benefits manager for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services; and
(B) The individual and aggregate amount a pharmacy benefits manager paid for pharmacist services itemized by pharmacy, product, and goods and services, including other prescription drug or device services.
(c) A pharmacy benefits manager is prohibited from conducting spread pricing in this state.
(d) This section does not limit the power of the commissioner to examine or audit the books and records of a pharmacy benefits manager under this subchapter.