A health benefit plan issuer that covers prescription drugs may not require an enrollee to make a payment for a prescription drug at the point of sale in an amount greater than the lesser of: the applicable copayment; the allowable claim amount for the prescription drug; or the amount an individual would pay for the drug if the individual purchased the drug without using a health benefit plan or any other source of drug benefits or discounts.

Link to Existing Law: V.T.C.A., Insurance Code § 1369.0041

While this law does not apply directly to DIR fees, it could prevent post-point-of-sale clawbacks when the patient’s copayment amount is greater than the amount the pharmacy stands to retain.