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TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 11 - HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER O - ADMINISTRATIVE PROCEDURES
SECTION/RULE §11.1404 - Pharmacy Application and Recertification
Chapter Review Date 05/05/2022

(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).

Source Note: The provisions of this §11.1404 adopted to be effective August 1, 2017, 42 TexReg 2169.

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