28 Tex. Admin. Code § 11.1404 - Pharmacy Application and Recertification

(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).

Notes

28 Tex. Admin. Code § 11.1404

The provisions of this §11.1404 adopted to be effective December 25, 1996, 21 TexReg 12100; amended to be effective February 24, 2005, 30 TexReg 854; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2252, eff. 8/1/2017