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Are pharmacy benefit managers (PBMs) or processing agents subject to HB 472 and the current administrator rules?

April 26, 2017agents benefit hb managers PBMs pharmacy Subject

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Are pharmacy benefit managers (PBMs) or processing agents subject to HB 472 and the current administrator rules?

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Any PBM collecting premiums or contributions from or adjusting or settling claims for residents of this state in connection with annuities or life, health, accident, pharmacy, or workers’ compensation benefits is acting as a TPA and is subject to provisions of HB 472 and the current administrator rules. HB 472 and the current administrator rules provide a separate exemption for workers’ compensation pharmacy processing agents meeting certain conditions (see section 4151.0021 of the Texas Insurance Code).