Tex.
Ins. Code Section 1551.067
Pharmacy Benefit Manager Contracts
(a)
In awarding a contract to provide pharmacy benefit manager services under this chapter, the board of trustees 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 board of trustees 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 board of trustees 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 board of trustees 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 board of trustees, 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 board of trustees.(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 board of trustees in accordance with established auditing standards.
Source:
Section 1551.067 — Pharmacy Benefit Manager Contracts, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1551.htm#1551.067 (accessed Jun. 5, 2024).
