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Current as of January 01, 2024 | Updated by Findlaw Staff
(a) A health benefit plan issuer or pharmacy benefit manager may not directly or indirectly reduce the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim through the use of an aggregated effective rate, quality assurance program, other direct or indirect remuneration fee, or otherwise, except in accordance with an audit performed under Subchapter F.
(b) Nothing in this section prohibits a health benefit plan issuer or pharmacy benefit manager from increasing a claim payment amount after adjudication of the claim.
Cite this article: FindLaw.com - Texas Insurance Code - INS § 1369.603. Reduction of Certain Claim Payment Amounts Prohibited - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1369-603/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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