One-Pager Opposing HB 1293: Mandating Fee-for-Service Pharmacy Rates in Medicaid Managed Care

TAHP opposes HB 1293 because it undermines one of the fundamental principles of the Medicaid managed care system and increases costs for taxpayers.

HB 1293 mandates the state’s fee-for-service (FFS) dispensing fee and the National Average Drug Acquisition Cost (NADAC) for prescription drug reimbursement in Medicaid managed care.

One of the main principles of Medicaid managed care is to negotiate market-based reimbursement rates to ensure affordable and accessible health care for Medicaid families while controlling costs for taxpayers.

By imposing a one-size-fits-all reimbursement model based on NADAC and the state’s dispensing fee, HB 1293 would effectively eliminate the ability of managed care organizations (MCOs) to negotiate competitive rates and drive down costs for Texas taxpayers.

View TAHP’s one-pager.

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