By Amanda C. Fields
General Counsel

The Texas Department of Insurance has stepped forward to help the pharmacy profession deal with prompt pay and audit issues with insurers and the entities they contract with to process, pay and audit claims, namely pharmacy benefit managers. You are invited to participate, along with TPBC staff and consultants, in an ongoing series of conference calls with TDI to enhance and refine this process.

The next call is Thursday, Sept. 10 at 1 p.m. Central. The number, which has changed since the TPA conference, is


TDI now is a valuable resource in the never-ending struggle to resolve these issues. Rather than fighting PBMs alone or hiring an attorney, you can send your complaints to TDI and have them properly resolved. There are going to be instances where TDI does not have jurisdiction over a complaint, but we encourage you to submit any and all complaints to TDI using their online form.

TDI uses information disclosed in this form to help resolve your complaint. Resolution may require TDI to share this information with the person or company named in your complaint. Although by law much of the information you submit may be considered public record, portions may be confidential.

For example, you may include private information protected by the doctrine of common law privacy, medical records protected by the Medical Practice Act, or an e-mail address provided for the purpose of communicating electronically with TDI, which is protected by the Texas Public Information Act. Sharing this information for purposes of processing your complaint does not waive these confidentiality protections. However, you may agree to the release of your e-mail address in response to a public information request or inquiry.

In addition, HIPAA allows doctors and health care providers to provide information about a person's health care to health oversight agencies such as TDI. The law permits doctors and providers to disclose this information without authorization if the disclosure is for any purpose for which the agency is legally authorized to collect information.

Please join this call to help ensure TDI is meeting your needs in resolving complaints. In addition to tomorrow's call, mark your calendars for the same time Oct. 8, Nov. 12, and Dec. 10.

TPBC staff and consultants have been working closely with TDI representatives, and the results have been positive, as our interaction has resulted in changes that will benefit the entire pharmacy profession. We want to be certain your issues are addressed, so please join the call if you can.  Also, we will continue to update you periodically in regard to these TDI outreach efforts, and provide you with important information on what TDI can do for you.

And use the TDI complaint form! It is in your interest to submit any and all complaints regarding insurers and PBMs to TDI so they will have a better understanding of the extent of your problems with these entities, particularly regarding prompt pay and audits. TDI is ready to process and resolve your complaint. Please bookmark the link and make your complaints known!

If you can't make the conference call, please send your questions and concerns about the TDI program to General Counsel Amanda C. Fields.