SB 1236 Texas Senate · 89th Legislature (2025)

Relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers.

SB 1236 requires health benefit plan issuers and pharmacy benefit managers in Texas to stop denying or reducing claim payments to pharmacists or pharmacies after a claim has been processed. It limits recoupments (recovery of overpayments) only to cases of fraud, duplicate payments, or specific errors (like wrong drug/dosage), and prohibits recouping dispensing fees for simple clerical mistakes. The bill also mandates that issuers provide pharmacists with secure online access to all pharmacy benefit network contracts, including any updates. These changes directly affect pharmacists, pharmacies, and health plans by clarifying payment rules and improving transparency in contract terms. The law takes effect September 1, 2025.
Bill status signed all 5 stages cleared
Introduction
Feb 2025
Committee Review
May 2025
Senate Passage
May 2025
House Passage
May 2025
Signed into Law
May 2025
Introduced Feb 12, 2025 Signed May 27, 2025
Maddy AI version diff · 2 comparisons

What changed between versions

Engrossed Enrolled · 6 edits · May 27, 2025
MODERATE
This bill amends the Texas Insurance Code to strengthen protections for pharmacists and pharmacies in their relationships with health benefit plan issuers and pharmacy benefit managers. Key changes include stricter rules on claim payment adjustments, enhanced transparency in pharmacy benefit network contracts, and new requirements for online access to contract information.
Scope change
The bill applies to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2026, and contracts entered into or renewed on or after the effective date of the Act.
REQUIREMENT

Added new provisions requiring health benefit plan issuers and pharmacy benefit managers to provide secure online portals for pharmacists to access all pharmacy benefit network contracts and addendums.

Modified recoupment rules to limit when issuers can recover payments from pharmacies, allowing recoupment only for fraudulent claims, incorrect payments, or substantive errors, with separate rules for clerical errors.

Added requirements that adverse material changes to pharmacy benefit network contracts require mutual agreement between parties and cannot take effect until 120 days after written affirmative agreement.

Added new sections requiring advance notice (90 days) for non-adverse contract modifications and electronic disclosure of fee schedules.

Added prohibitions on requiring pharmacists to participate in pharmacy benefit networks or penalizing them for refusing to participate.

TIMELINE

Extended effective date to September 1, 2025, with provisions applying to plans and contracts starting January 1, 2026.

Floor votes · House May 12, 2025

How they voted

This bill passed the Senate by voice vote (no roll call recorded).
Full legislative history

Actions timeline

Total actions
49
Key actions
15
Committee
10
May 27, 2025
Signed into law
Signed by the Governor
executive
May 15, 2025
Lower · Passed
Signed in the House
lower
May 15, 2025
Upper · Passed
Signed in the Senate
upper
May 14, 2025
Upper · Passed
House passage reported
upper
May 13, 2025
Lower · Passed
Passed
lower
May 12, 2025
House · Passed
House Vote: pass (140-0-4)
house
May 8, 2025
Lower · Passed
Committee report sent to Calendars
lower
May 7, 2025
Lower · Passed
Committee report distributed
lower
May 7, 2025
Lower · Passed
Reported favorably w/o amendment(s)
lower
Apr 28, 2025
Committee
Referred to Insurance
lower
Apr 28, 2025
Introduced
Read first time
lower
Apr 25, 2025
Introduced
Received from the Senate
lower
Apr 24, 2025
Upper · Passed
Passed
upper
Apr 14, 2025
Upper · Passed
Committee report printed and distributed
upper
Apr 14, 2025
Upper · Passed
Reported favorably as substituted
upper
Apr 10, 2025
Upper · Passed
Vote taken in committee
upper
Apr 1, 2025
Upper · Passed
Left pending in committee
upper
Apr 1, 2025
Upper · Passed
Testimony taken in committee
upper
Feb 28, 2025
Committee
Referred to Health & Human Services
upper
Feb 28, 2025
Introduced
Read first time
upper
3 primary · 2 co-sponsors

Sponsors