Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter BB - PHARMACEUTICAL SERVICES
Section 3.4204 - Pharmacy Application and Recertification
Universal Citation: 28 TX Admin Code § 3.4204
Current through Reg. 50, No. 13; March 28, 2025
(a) An insurer may establish reasonable application and recertification fees for each licensed pharmacy which participates or applies to participate as a contract provider under a health insurance policy. An application or recertification fee charged under this section shall be considered reasonable provided:
(1) the fee does not exceed $50 per licensed
pharmacy;
(2) the fee shall be
uniformly charged per application or recertification to each pharmacy holding a
license issued by the Texas State Board of Pharmacy;
(3) an insurer that contracts for the
pharmaceutical services of more than one licensed pharmacy under common
ownership or affiliation shall charge a separate fee for each licensed
pharmacy;
(4) no more than one fee
per licensed pharmacy is charged by an insurer for processing an application
for participation as a contract provider under all health insurance policies
and in any or all networks utilized by the insurer; and
(5) no more than one fee per licensed
pharmacy is charged by a health maintenance organization or insurer within an
insurance holding company system, as defined in Insurance Code, Article
21.49-1, §2, utilizing common networks.
(b) An insurer shall not require any pharmacy or pharmacist participating or applying to participate as a contract provider under a health insurance policy:
(1) to
provide financial statements to the insurer; and
(2) to deposit with the insurer any monies or
other forms of compensation except for reasonable application and
recertification fees.
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