Relating to the minimum reimbursement amount for prescription drugs and devices to health benefit plan network pharmacists and pharmacies.

SB 1354 requires pharmacy benefit managers (PBMs) to reimburse network pharmacists and pharmacies for prescription drugs and devices at no less than the actual cost to the pharmacy, as defined in Section 1369.374(a) of the Texas Insurance Code. It also mandates that PBMs pay a professional dispensing fee equal to the amount paid under the Medicaid fee-for-service model (Section 1369.374(d)), and prohibits PBMs from including dispensing fees in their reimbursement calculations (Section 1369.374(c)). The bill establishes a formal appeal process for pharmacies to challenge reimbursements below these minimums, requiring PBMs to provide standardized appeal procedures approved by the commissioner (Sections 1369.375-377). This applies to most health benefit plans but excludes Medicaid, TRICARE, workers’ compensation, and other specified programs (Section 1369.373).