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TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER 3.4204.html - null
SECTION/RULE §3.4204 - Pharmacy Application and Recertification
Chapter Review Date 05/06/2022

(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.

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

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