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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER BBPHARMACEUTICAL SERVICES
RULE §3.4204Pharmacy 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.


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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