Texas Insurance Code 1369.605 – Network Contract Fee Schedule
Current as of: 2024 | Check for updates
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Terms Used In Texas Insurance Code 1369.605
- Contract: A legal written agreement that becomes binding when signed.
- in writing: includes any representation of words, letters, or figures, whether by writing, printing, or other means. See Texas Government Code 312.011
A pharmacy benefit network contract must specify or reference a separate fee schedule. Unless otherwise available in the contract, the fee schedule must be provided electronically in an easily accessible and complete spreadsheet format and, on request, in writing to each contracted pharmacist and pharmacy. The fee schedule must describe:
(1) specific services or procedures that the pharmacist or pharmacy may deliver and the amount of the corresponding payment;
(2) a methodology for calculating the amount of the payment based on a published fee schedule; or
(3) any other reasonable manner that provides an ascertainable amount for payment for services.