TX HB2978

Prohibits pharmacy benefit managers (PBMs) from reimbursing network pharmacists and pharmacies less than the actual cost of prescription drugs and devices, with an exception for PBMs using the Medicaid fee-for-service reimbursement methodology

Requires PBMs to pay professional dispensing fees at least equal to the Medicaid fee-for-service rate, separate from and in addition to drug/device reimbursement

Establishes a mandatory appeal process allowing pharmacists or pharmacies to challenge inadequate reimbursements within 7 days of payment, using a commissioner-approved standard form

Requires PBMs to apply successful appeal outcomes to all similarly situated pharmacists and pharmacies who purchase from the same wholesaler, not just the appealing party

Exempts state Medicaid, CHIP, TRICARE, state employee/teacher/university health plans, and workers' compensation from these requirements; applies to health benefit plans delivered or renewed on or after January 1, 2026