28 Tex. Admin. Code § 3.4204 - Pharmacy Application and Recertification

(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.

Notes

28 Tex. Admin. Code § 3.4204

The provisions of this §3.4204 adopted to be effective December 25, 1996, 21 TexReg 11947; transferred effective April 16, 1999, 24 TexReg 3092.