1. (a) An HMO subject to the requirements of the Texas Insurance Code, Article 21.52B, as amended, may establish reasonable application and recertification fees for each licensed pharmacy which participates or applies to participate as a contract provider in an HMO delivery network.

2. (b) An application or recertification fee charged under this section shall be considered reasonable provided:

   1. (1) the fee does not exceed $50 per licensed pharmacy;
   2. (2) the fee shall be uniformly charged per application or recertification to each pharmacy holding a license issued by the Texas State Board of Pharmacy;
   3. (3) an HMO that contracts for the pharmaceutical services of more than one licensed pharmacy under common ownership or affiliation shall charge a separate fee for each licensed pharmacy;
   4. (4) no more than one fee per licensed pharmacy is charged by an HMO for processing an application or recertification for participation as a contract provider under more than one group or individual contract or in more than one HMO delivery network; and
   5. (5) no more than one fee per licensed pharmacy is charged by any HMO or insurer within the same insurance holding company system, as defined in the Insurance Code, Article 21.49-1, §2, utilizing common networks.

3. (c) An HMO shall not require any pharmacy or pharmacist participating or applying to participate as a contract provider in an HMO delivery network:

   1. (1) to provide financial statements to the HMO; and
   2. (2) to deposit with the HMO any monies or other form of consideration, except for reasonable application and recertification fees.

Source Note:The provisions of this §11.1404 adopted to be effective December 25, 1996, 21 TexReg 12100.