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Dec
16

Rumors of a solution to Texas’ PBM problem

I’m reluctant to post this. There have been so many false starts and so much confusion around the issue of PBMs’ status in Texas that the latest ‘news’ sounds too good to be true.
I have heard from two credible sources that Texas’ Department of Work Comp will file emergency regulations permitting PBMs to continue operating until legislation addressing the issue around their status is passed in the next legislative session.
Unless DWC – or another entity intervenes, as of now – 7 am in Phoenix – PBMs will be out of business in Texas after 1/1/11 – they are considered ‘involuntary networks (well, at least they ‘appear’ to be considered involuntary networks, but some disagree…) which cannot operate after the first of the year.
While some are saying involuntary networks should continue as legislation will retroactively permit their operation, that’s a very – very – high stakes gamble – loss of license plus a $25 grand per day fine for transgressors.
For more on the history click here.


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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