TX SB1236

Prohibits health benefit plan issuers and pharmacy benefit managers (PBMs) from denying or reducing pharmacy claim payments after adjudication, except for fraud, duplicate payments, or substantive errors resulting in wrong drug/dosage; limits recoupment to dispensing fee only for clerical errors

Requires PBMs and insurers to provide pharmacies secure online portal access to all pharmacy benefit network contracts, including addendums, and prohibits charging application or participation fees before providing full contract terms

Mandates that "adverse material changes" to pharmacy contracts (payment decreases, tier demotions, administrative cost increases) require mutual written agreement and cannot take effect until 120 days after pharmacy consent; unilateral change provisions are void and unenforceable

Requires 90 days advance notice for non-adverse contract modifications, with pharmacy deemed to approve if no response within 31 days; prohibits incorporating external documents by reference and requires all financial terms be stated in the contract

Bars PBMs from requiring pharmacy participation in any network, conditioning participation in one network on joining another, or penalizing pharmacies for refusing to participate; takes effect September 1, 2025