Texas § 1601.064 PHARMACY BENEFIT MANAGER CONTRACTS.

Texas Statutes

§ 1601.064 — PHARMACY BENEFIT MANAGER CONTRACTS.

Texas § 1601.064

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Bluebook

Tex. Insurance Code Code Ann. § 1601.064 (2026).

Text

Sec. 1601.064. PHARMACY BENEFIT MANAGER CONTRACTS.

(a)In awarding a contract to provide pharmacy benefit manager services under this chapter, a system is not required to select the lowest bid but must select a contract that meets the criteria established by this section.

(b)The contract must state that:

(1)the system is entitled to audit the pharmacy benefit manager to verify costs and discounts associated with drug claims, pharmacy benefit manager compliance with contract requirements, and services provided by subcontractors;

(2)the audit must be conducted by an independent auditor in accordance with established auditing standards; and

(3)to conduct the audit, the system and the independent auditor are entitled access to information related to the services and the costs associated wi

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Sec. 1601.064. PHARMACY BENEFIT MANAGER CONTRACTS. (a) In awarding a contract to provide pharmacy benefit manager services under this chapter, a system is not required to select the lowest bid but must select a contract that meets the criteria established by this section.
(b) The contract must state that:
(1) the system is entitled to audit the pharmacy benefit manager to verify costs and discounts associated with drug claims, pharmacy benefit manager compliance with contract requirements, and services provided by subcontractors;
(2) the audit must be conducted by an independent auditor in accordance with established auditing standards; and
(3) to conduct the audit, the system and the independent auditor are entitled access to information related to the services and the costs associated with the services performed under the contract, including access to the pharmacy benefit manager's facilities, records, contracts, medical records, and agreements with subcontractors.
(c) The contract must define the information that the pharmacy benefit manager is required to provide to the system concerning the audit of the retail, independent, and mail order pharmacies performing services under the contract and describe how the results of these audits must be reported to the system, including how often the results must be reported. The contract must state whether the pharmacy benefit manager is required to return recovered overpayments to the system.
(d) The contract must state that any audit of a mail order pharmacy owned by the pharmacy benefit manager must be conducted by an independent auditor selected by the system in accordance with established auditing standards.
SUBCHAPTER C. COVERAGE AND PARTICIPATION