Insight, analysis & opinion from Joe Paduda

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Dec
20

The Texas work comp PBM rules are up

For those who were following with bated breath the efforts of many to forestall the end of PBMs in Texas, Friday brought official confirmation of the rumors that we reported last week: the Division of Workers Comp published emergency regs [opens pdf of actual rules] that:
– make the Attorney General’s opinion moot;
enable PBMs to operate in Texas after 1/1/11; and
– call on the legislature to pass a permanent fix.
So, on 1/1/11, PBMs can continue operating just as they do today.
Hallalooya.
Here’s the key language from DWC’s memo [opens pdf]:
“The rule amendments may remain in effect for a maximum of 180 days if renewed.
The adopted amendments permit insurance carriers to continue to reimburse prescription drugs dispensed on or after January 1, 2011 at rates either above or below the fees determined by the Division’s fee guideline using written contracts between insurance carriers and pharmacies or their processing agents, if applicable.”
I’m waiting for guidance on the 180 day issue: you’ll know when I do.


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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