House Representative

Guerra, Bobby



AUSTIN, TX –State Representative R.D. "Bobby" Guerra (McAllen) unveiled H.B. 255, relating to certain fees charged for adjudication of claims under health benefit plans.

H.B. 255 is a critical piece of legislation for independent pharmacists statewide who continue to be unjustly charged excessive transactional fees from Pharmacy Benefit Managers (PBMs) who contract with health benefit plans (HMOs) to process prescription claims for pharmacists. This legislation was crafted in conjunction with the Texas Department of Insurance (TDI) to give their agency the enforcement tools they need to close creative loopholes being utilized by PBMs.

The Texas Insurance Code, Sec. 1213.005, prohibits health benefit plans (HMOs) and the entities administering plan benefits on their behalf from charging a fee for the submission and adjudication of a healthcare claim. This section of code was enacted in 2005. Nine years later, PBMs continue to find loopholes in current law and charge fees for adjudication of claims.

During today’s committee hearing, TDI testified that PBMs have been in direct violation of the Insurance Code and continue to avoid the agency’s enforcement actions by creatively coding their transaction fees. H.B. 255 intends to close this loophole in the Insurance Code so that PBMs shall not directly or indirectly charge a pharmacist or pharmacy for a fee for any part of the claim adjudication process.

Rep. Guerra’s H.B. 255 is a bipartisan effort signed on to by Rep. Munoz, Raney & Dr. Sheffield. Senator Hinojosa filed the companion bill in the Senate, S.B. 94. This bill was left pending in the House Insurance committee to give Members the opportunity to study the legislation.

“I am pleased with how this afternoon’s hearing went. I am confident that Chairman Frullo and Members of the Insurance Committee understand the issue, and more importantly, how this legislation would serve to protect our pharmacists statewide, who for the most part are our small business owners. I look forward to working with my colleagues on this issue and other important legislation that will come before the committee during the upcoming months,” Guerra said.

Contact: Aisa Showery
Legislative Director
(512) 463- 0578 office