Legislation Unanimously Passes Senate; Heads to House Calendars CommitteeCommunity pharmacy and major PBMs signed off on compromise language for pharmacy prompt pay legislation late Friday that strategists say sets the stage for success on one of pharmacy’s biggest issues in the Texas Legislature. Pushed by a coalition of community pharmacy groups including PBA Health/TrueCare, the bill includes important proposals for the future of the industry including new rules concerning auditing standards, prompt payment and electronic fund transfers. 
The compromise on the number of days that PBMs have to pay clean claims by electronic fund transfer, came after State Sen. Leticia Van de Putte, D-San Antonio, passed her version out of the Senate by a unanimous vote on Wednesday. The House version of the bill by Rep. Todd Hunter, R-Corpus Christi, had already passed out of the Insurance Committee and had been sent to the Calendars Committee. It has not yet come up for a vote by the House of Representatives.
“I have never had a prompt pay bill pass so easily in the Texas Senate,” said Van de Putte, the only pharmacist serving in the Texas Senate. “It is a testament to the great relationships that pharmacy has built with legislators and the work that pharmacy does at the state capitol. It’s about time that health plans and insurers treat pharmacy fairly. No longer will they be able to hide behind sneaky techniques to avoid prompt payments to pharmacy.” Van de Putte said not one senator even asked her a question on the legislation which was considered one of the most important issues for pharmacy during this session. She credited that with the work that groups like TrueCare have done in the past few years in educating legislators about pharmacy issues. The Senate bill was identical to one sent to the House Calendars Committee last week. But even though the bill had gone to Calendars where it was to be set for a vote on the House Floor, Hunter wanted to make sure that all sides agreed not to oppose the final proposal. 
Hunter and his staff continued negotiations with all interested groups on the legislation to get an acceptable compromise. In a series of meetings, Hunter’s office met with representatives of major PBMs, the Pharmacy Business Council and TrueCare Pharmacy to reach a negotiated compromise where all parties would agree not to fight any portion of the legislation.
“Our legislative council voted to sign off on a compromise that gave PBMs 18 days instead of the 14 days outlined in the bill to pay clean claims by Electronic Funds Transfer,” said Truecare’s lead lobbyist Robert Culley. “This legislation now has a very, very good chance of passing and we are encouraged about the progress pharmacy has made in this legislative session.” An analysis of the bill by the Texas Legislative Council says the new legislation reflects existing technology and the fact that the majority of pharmacy claims are filed electronically. “The pharmacy profession’s use of electronic technology in its business operations saves money for employers, patients and health care providers,” the analysis states. “This bill requires affirmatively adjudicated electronic claims to be paid to pharmacies via electronic funds transfer and shortens the payment period.” Hunter is a longtime friend of small business and community pharmacy. One of his constituents is Texas Pharmacy Association President Bill Moore and one of the interns in his office is the daughter of longtime TrueCare pharmacist Yolanda Villarreal of Corpus Christi. Both Villarreal, a member of the Calallen school board, and Moore, are friends of Hunter and helped to enlist his support and to carry the bill in the House.  “This bill will help ensure that Texas community pharmacists get some relief from the cash flow pinch that comes when they aren’t paid promptly for their services,” Hunter said. “Small businesses need to maintain a strong cash flow to operate effectively and efficiently. That is especially important to community pharmacies which are a vital part of our state’s health care system.” In addition the bill allows a pharmacy a reasonable amount of time to make necessary staffing changes to maintain patient care before on-site audits occur. It also established a specific complaint filing and resolution process with the Texas Department of Insurance for allegations of noncompliance with prompt pay and audit standards, including an appeals process with the State Office of Administrative Hearings. “This bill not only shortens the deadline for paying pharmacies on clean claims, it also bans the inequitable practice of extrapolation or from requiring extrapolation audits as a condition for participating in contracts or networks ,” said TrueCare Government Affairs Director John Heal. The bill has two of the state’s most trusted legislators authoring the bill. Van de Putte serves as chair of the Senate Armed Services Committee and Hunter chairs the Judiciary and Civil Jurisprudence Committee in the House. |
We Need Your Help!
The narrow margin of Texas Pharmacist Chuck Hopson’s victory is another example of how one election can make a difference in independent pharmacy’s ability to get its message to the decision makers of the future. We must be ready and able to work with both political parties and with a variety of different lawmakers to ensure that our voice will be heard. Today we must decide if we want to be participants, or spectators in the legislative and regulatory arenas. Participants have a say in their destiny. Spectators watch from the sidelines and read tomorrow’s newspaper to find out what happened. We must be proactive, and not reactive. In the past, many of you have shown a commitment to the future of pharmacy by supporting the Texas Pharmacy Survival Fund, which has been instrumental in protecting the interests of independent pharmacy. Today pharmacies continue to reap the rewards from the work of the Survival Fund as it expands its grassroots efforts to educate legislators, opinion makers and the general public on issues important to independent pharmacy. We need your help again. In January we will face another legislative session and we cannot afford to wait two months to begin getting out pharmacy’s message to new legislators and legislative leaders. There is much work to be done and pharmacy needs your help to ensure that we maintain our momentum. Our voices must be heard in Austin. Please make a contribution to the future of independent pharmacy through the Pharmacy Survival Fund. The stakes have never been so high. Respectfully,
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Tammy Gray |
Carlos Solis |
Doyl Langwell |
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Rene Garza |
Allan Pavia |
David Haney |
TrueCare Texas -
John Heal |