Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter O - ADMINISTRATIVE PROCEDURES
Section 11.1404 - Pharmacy Application and Recertification
Universal Citation: 28 TX Admin Code § 11.1404
Current through Reg. 50, No. 13; March 28, 2025
(a) An HMO may not require any pharmacy or pharmacist participating or applying to participate as a contracted provider in an HMO delivery network to:
(1) provide
financial statements to the HMO; or
(2) deposit with the HMO any monies or other
form of consideration, except for reasonable application and recertification
fees.
(b) An HMO or a pharmacy benefit manager may not directly or indirectly charge or hold a pharmacist or pharmacy responsible for a fee for any step of, or component or mechanism related to, the claim adjudication process in violation of Insurance Code § 1369.402 (concerning Certain Fees Prohibited).
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