TX HB3317

Health benefit plan issuers and pharmacy benefit managers (PBMs) are prohibited from denying or reducing claim payments to pharmacists or pharmacies after claim adjudication, except for fraud, duplicate payments, or substantive errors resulting in wrong drugs or dosages

Adverse material changes to pharmacy network contracts (such as decreased payment, tier demotions, or increased administrative burdens) require mutual written agreement from pharmacists/pharmacies and cannot take effect until 120 days after agreement

PBMs must provide pharmacists and pharmacies access to a secure online portal containing all network contracts, addendums, and provider manuals, with 90 days advance notice required for non-adverse contract modifications

PBMs are prohibited from requiring pharmacies to participate in networks, conditioning participation on joining other networks, penalizing refusal to participate, or charging fees before providing full contract terms

Fee schedules must be included directly in pharmacy network contracts rather than referenced separately, and group numbers on insurance ID cards must only be assigned to enrollees in applicable health benefit plans; provisions take effect September 1, 2025