AI-assisted research summary: The commission must make enrollees share program costs, including copayments and administration charges, subject to stated limits.
Sec. 65.152. COST SHARING. (a) To the extent necessary, the commission shall require enrollees to share the cost of the program, including requiring enrollees to pay a copayment at the point of sale of a prescription drug. (b) The commission must: (1) allow an enrollee to pay all or part of the enrollee's share from any source the enrollee selects; and (2) accept another assistance program if that assistance program wholly or partly covers the enrollee share of the prescription drug cost. (c) The commission shall require an enrollee to pay a copayment to compensate the pharmacy, pharmacy benefit manager, and commission for the costs of administering the program in accordance with Subsection (d) and under the methodology determined by the commission. (d) Enrollees shall pay the costs of ongoing administration of the program through an additional charge at the point of sale of an eligible prescription drug only if the total number of enrollees in the program allows for the additional charge to be an amount not to exceed the lesser of: (1) an amount similar to the amount charged for a prescription drug in other state pharmaceutical assistance programs administered by the commission; or (2) 10 percent of the total amount charged at the point of sale for the prescription drug. Added by Acts 2021, 87th Leg., R.S., Ch. 626 (H.B. 18), Sec. 2, eff. September 1, 2021. SUBCHAPTER E. OPERATION OF PROGRAM