TX SB1354

Prohibits pharmacy benefit managers (PBMs) from reimbursing network pharmacists and pharmacies less than their actual cost for prescription drugs and devices

Requires PBMs to pay professional dispensing fees at least equal to the Medicaid fee-for-service rate, and these fees cannot be counted toward meeting the minimum reimbursement requirement

Exempts certain programs including state Medicaid, CHIP, TRICARE, state employee health plans (Chapters 1551, 1575, 1579, 1601), and workers' compensation insurance

Mandates PBMs establish commissioner-approved appeal procedures allowing pharmacies to challenge inadequate reimbursements within 7 days; successful appeals require corrections within 7 days and must extend to similarly situated pharmacies using the same wholesaler

When PBMs prevail on appeal, they must provide pharmacies with information on wholesalers offering the drug at the challenged reimbursement price; failure to do so requires adjusting reimbursement to cover actual costs

Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2026, with an effective date of September 1, 2025