RxCe - Recent Updates to Texas Pharmacy Laws & Rules Materials

TEXAS PHARMACY LAWS AND RULES AND

RECENT UPDATES

Faculty:

Pamela Sardo, PharmD, BS

Pamela Sardo, PharmD, BS, is a freelance medical writer and licensed pharmacist. She is the founder and principal at Sardo Solutions in Texas. Pam received her BS from the University of Connecticut and her PharmD from the University of Rhode Island. Pam’s career spans many years in retail, clinics, hospitals, long-term care, Veterans Affairs, and managed health care responsibilities across a broad range of therapeutic classes and disease states.

Abstract

Healthcare, including pharmacy practice, is a highly regulated profession. This course provides updates on recent changes to Texas pharmacy laws and rules including patient counseling, updated compounding rules (sterile/non-sterile), continuing education, eligibility of persons with criminal backgrounds, alternative registration and licensing procedures, expedited licensing procedures, and interim license procedures for a military service member, military veteran, or military spouse, updated definitions, drone delivery, amendments remove inventory notarization requirements, new fees, dispensing Ivermectin, and new pharmacy technician-to-pharmacist ratios at central fill locations. As pharmacy team members learn and adhere to the updates, they support the Texas State Board of Pharmacy's mission to prioritize the health and safety of Texas citizens.

Accreditation Statements

In support of improving patient care, RxCe.com LLC is jointly accredited by the Accreditation Council^TM for Continuing Medical Education (ACCME^®), the Accreditation Council for Pharmacy Education (ACPE^®), and the American Nurses Credentialing Center (ANCC^®), to provide continuing education for the healthcare team.

Joint Universal Activity Number: The Joint Accreditation Universal Activity Numbers assigned to this activity are as follows:

Pharmacists: JA4008424-0000-26-056-H03-P

Pharmacy Technicians: JA4008424-0000-26-056-H03-T

Credits: 1 contact hour(s) (0.1 CEU(s)) of continuing education credit.

Credit Types:

Pharmacy - 1 Credit

Type of Activity: Knowledge

Media: Computer-Based Training (i.e., online courses)

Estimated time to complete activity: 1 contact hour(s) (0.1 CEU(s)), including Activity Pre-Test, Post-Test, and Activity Evaluation.

Release Date: April 25, 2026 Expiration Date: April 25, 2029

Target Audience: This educational activity is for Pharmacists and Pharmacy Technicians

How to Earn Credit: From April 25, 2026, through April 25, 2029, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Take the “Educational Activity Pre-Test;”

Study the section entitled “Educational Activity;” and

Complete the Educational Activity Post-Test and Activity Evaluation. The Educational Activity Post-Test will be graded automatically. Following successful completion of the Educational Activity Post-Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

CME Credit: Credit for this course will be uploaded to CPE Monitor^® for pharmacists. Physicians may receive AMA PRA Category 1 Credit™️ and use these credits toward Maintenance of Certification (MOC) requirements. Physician Assistants may earn AAPA Category 1 CME credit, reportable through PA Portfolio. All learners shall verify their individual licensing board’s specific requirements and eligibility criteria.

Statement of Need

Texas pharmacists and pharmacy technicians must keep pace with frequent statutory and regulatory changes affecting licensure, compounding, dispensing, counseling, delivery, and compliance. Unfortunately, gaps remain in knowledge, application, and skills, as evidenced by deficiencies noted and reported during pharmacy inspections. The Texas State Board of Pharmacy continues to refine regulatory authority, oversight, and collaboration with other federal agencies. Practitioners need a current understanding of where to find authoritative rules and amendments for safe and lawful practice. The relevance is that changes in rules and laws can alter workflows, documentation, and patient care responsibilities across practice settings. This activity aims to address the Board’s powers and duties and directs pharmacy professionals to the Texas Pharmacy Act, the Texas Administrative Code, and additional resources. The goal is to highlight recent updates to practice rules that affect daily operations and patient safety.

Learning Objectives: Upon completion of this educational activity, participants should be able to:

Explain the powers and duties of the Texas State Board of Pharmacy

Describe where to locate Texas pharmacy rules and laws

Describe recent changes to Texas pharmacy practice rules

Disclosures

The following individuals were involved in planning, developing, and/or authoring this activity: Pamela Sardo, PharmD, BS. Pamela Sardo has no conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.

Educational Activity Pre-Test

Which activity best illustrates a core responsibility of the Texas State Board of Pharmacy?

Mandating that all pharmacies use a single state-approved pharmacy management software system

Negotiating drug prices directly with the pharmaceutical manufacturers on behalf of all Texas pharmacies

Issuing and renewing pharmacist and pharmacy licenses, and disciplining licensees for violations

Setting wholesale acquisition costs for prescription drugs dispensed in Texas pharmacies

You are a newly licensed Texas pharmacist and need to verify the most current rules on pharmacist responsibility for patient counseling. Where is the best place to find the official, up-to-date rules?

The Food and Drug Administration website, newsletter, and Food, Drug, and Cosmetics Act

The Texas Health and Human Services website and newsletters

The Texas Board of Pharmacy website, newsletter, and Texas Administrative Code Title 22, Part 15

The worksite's internal policies and procedures manual was approved by corporate headquarters

Which of the following best describes the Texas State Board of Pharmacy's new pharmacy drone delivery rules?

A pharmacist or pharmacy may deliver prescription drugs by means of a contract carrier and certain prescription drugs by use of unmanned aircraft systems.

A drone delivery shipment is only allowed if the prescription order includes controlled substances and sterile compounded preparations.

The drone delivery rules allow pharmacies to use individual neighborhood citizens who own and operate drones as contract carriers.

A contract carrier must ensure packaging protects product integrity, but does not need to document chain-of-custody steps

Educational Activity

Texas Pharmacy Laws and Rules and Recent Updates

Introduction

Pharmacy practice is highly regulated. The Texas State Board of Pharmacy has been very active over the past year, implementing numerous amendments following the most recent Texas legislative session. Pharmacy practice laws and rules change to update educational requirements and processes and to address patient care and safety. Some updates are minor (grammar or vocabulary edits), while others modify requirements. Others are detailed and important for daily practice. This course highlights recent changes to Texas pharmacy laws and rules and their impact on daily pharmacy practice. These changes are relevant for pharmacists, pharmacy technicians, and anyone with regulatory permission to possess, administer, and dispense pharmaceuticals, such as in a medical practice clinic setting. This continuing education activity is organized by communicating the most recent updates first, with earlier effective dates and related topics located further in the article. The updates in this course are also separated by license type (i.e., pharmacist, intern, or pharmacy technician) as described in updates to board rules or laws.

Recent 2026 changes to Texas pharmacy laws and rules included patient counseling, updated compounding rules (sterile/non-sterile), continuing education, eligibility of persons with criminal backgrounds, alternative registration and licensing procedures, expedited licensing procedures, and interim license procedures for a military service member, military veteran, or military spouse, updated definitions, drone delivery, amendments remove inventory notarization requirements, new fees, dispensing Ivermectin, and new pharmacy technician-to-pharmacist ratios at central fill locations.

Texas State Board of Pharmacy

Pharmacy professions are among the most regulated industries because healthcare deeply impacts people's lives and could cause harm if unregulated.¹ The Texas State Board of Pharmacy (TSBP) regulates pharmacy practice in Texas.² The purpose of the Board is to promote, preserve, and protect the health, safety, and welfare of the people of Texas by regulating the practice of pharmacy in the public interest.² The Agency accomplishes its purpose by ensuring that the quality of skill levels among those entering the practice of pharmacy is maintained.² Those skills include adhering to quality standards for professional practice and ensuring the controlled distribution of prescription drugs. They oversee the prevention of misuse and diversion of prescription drugs from pharmacies and cooperate with other state and federal agencies.²

The TSBP is composed of 11 members appointed by the Governor, with the concurrence of the Senate, for overlapping six-year terms.³ Seven members must have been licensed as pharmacists in Texas for five years immediately preceding appointment and must continue to actively practice pharmacy while serving. One member must have been registered as a pharmacy technician in Texas for five years immediately preceding appointment and must continue to actively work as a pharmacy technician while serving. Three members must represent the public. The Board meets quarterly in Austin.³

The Board is an independent state health regulatory agency established to regulate the practice of pharmacy and to protect the health, safety, and welfare of Texas citizens.^2,4 The TSBP develops and sets policy. It regulates pharmacists, pharmacies, pharmacy technicians, pharmacy technician trainees, and the legal distribution of prescription drugs through pharmacies in Texas.² The Board publishes its rules, which are available online.⁴

Texas State Board of Pharmacy Board Rules

March 1, 2026⁴

TEXAS ADMINISTRATIVE CODE TITLE 22 – EXAMINING BOARDS PART 15 – TEXAS STATE BOARD OF PHARMACY

Link: https://www.pharmacy.texas.gov/files_pdf/tsbp%20rules_master%20file.pdf#:~:text=§281.1%20Objective%20and%20Scope,matter%20within%20the%20jurisdiction%20of

The TSBP licenses all pharmacies operating in Texas except those located in federal facilities, and it licenses/registers pharmacists, pharmacy technicians, and pharmacy technician trainees, as well as their license/registration renewals.²

The licensed pharmacies include community pharmacies (retail), institutional pharmacies (hospitals), clinic pharmacies (Planned Parenthood, etc.), nuclear pharmacies (pharmacies dispensing radiopharmaceuticals), and out-of-state mail-order pharmacies (pharmacies located in another state that fill prescriptions and deliver them to Texas residents). The TSBP also inspects pharmacies, investigates complaints, and disciplines violators of pharmacy laws.²

Texas Board of Pharmacy Amended Rules

The TSBP operates under the provisions of various Texas laws, such as the Texas Pharmacy Act, Texas Dangerous Drug Act, Texas Administrative Procedures Act, Open Records Act, Open Meetings Act, and Sunset Act.² The agency's financial records are audited annually by the State Auditor. Also, the Legislature oversees the TSBP income and expenses through the biennial budget appropriation process. The TSBP website is the optimal resource for updates regarding pharmacy practice. The TSBP website, https://www.pharmacy.texas.gov/, includes an easy-to-use “Laws and Rules” tab that provides access to the Texas Administrative Code, Title 22, Part 15. It also includes news and notices.

Recently adopted rule change summaries can be located at the following link:

https://www.pharmacy.texas.gov/Rules_Recent_Adopted_Changes.asp within the TSBP website.

Patient Counseling

The amendments to 22 TAC §291.33 allow written information reinforcing patient counseling to be provided electronically, unless requested in hard copy, and remove the requirement to document the request.⁵ This also applies to Class E, nonresident pharmacies, as explained in 22 TAC §291.104.⁶

Updated Compounding Rules

Table 1 provides select highlights within the Texas Pharmacy rule updates reflecting sterile compounding in 22 TAC 291.133.⁷ Refer to 22 TAC 291.133 for comprehensive information, as this table reinforces consumer protection goals under the Texas Pharmacy Act and requires compliance, but is not a complete list.

Updated Compounding Rules

Topic

Key Updates

Purpose

Establishes standards for sterile preparations in Class A-S, B, C-S, and E-S pharmacies.

Applies to related pharmacies under common ownership.

Personnel

Requires pharmacist-in-charge to oversee training, competency, and supervision.

Requires initial sterile compounding training.

Requires annual written competency testing and periodic media-fill testing

Requires hand hygiene, garbing, and validation of aseptic technique before patient use.

Requires reevaluation after failed testing or observed deficiencies.

Expands oversight responsibilities to non-compounding personnel involved in supervision, verification, or environmental support.

Operational Standards

Adopts Category 1, 2, nd 3 CSP requirements.

Strengthens standards for cleanrooms, buffer rooms, anterooms, and PECs.

Expands environmental monitoring and surface sampling obligations.

Tightens cleaning and disinfection requirements.

Updates labeling, recordkeeping, and master formulation documentation.

Limits the immediate use of CSPs to defined circumstances and timeframes.

Refines beyond-use-dting and storage rules.

Adds more explicit hazardous drug handling and waste requirements.

Strengthens quality assurance and sterility controls.

Amendments Related to Continuing Education

The amendments to 22 TAC §295.8 and 22 TAC §297.8 establish an electronic continuing education tracking system in accordance with Senate Bill 912.^8,9 These amendments updated the continuing education programs in preparation for the statutory continuing education tracking system, specified that record retention requirements apply to all required courses, and made grammatical corrections. This impacts pharmacists, pharmacy technicians, and pharmacy technician trainees.^8,9

Criminal Backgrounds

Amendments to §281.63 concerning Considerations for Criminal Offenses establish guidelines and criteria for the eligibility of persons with criminal backgrounds to obtain a license or registration from the board, as well as for the disciplinary actions the board may take.¹⁰ The board may suspend, revoke, or impose other authorized disciplinary action on a current license or registration, disqualify a person from receiving a license or registration, or deny a person the opportunity to be examined for a license or registration because of a person's conviction or deferred adjudication of a crime that serves as a ground for discipline under the Act. The board may revoke a license or registration upon the imprisonment of the licensee, the registrant, or the owner of a pharmacy following a felony conviction or deferred adjudication.¹⁰

Licenses for Military Service Members, Veterans, and Spouses

The Board adopted amendments to 22 TAC §297.10 and §283.12, updating the alternative registration and licensing procedures, expedited licensing procedures, and interim license procedures for a military service member, military veteran, or military spouse, in accordance with House Bill 5629.^11,12 This bill established provisional license procedures for a military service member, military veteran, or military spouse, in accordance with Senate Bill 1818. It also made grammatical corrections.

Definitions

The Board established certain definitions within §291.31, §291.52, and §291.12, and §291.72.^13-16 These definitions apply to the terms "common ownership" and "owner of record" in community, nuclear, and institutional pharmacy.

Drone Delivery

The Texas State Board of Pharmacy adopted this change to the services provided by pharmacies under § § 291.9 and 291.12. It concerns Prescription Pick Up Locations and Delivery.^17-20 The amendments allow a pharmacist or pharmacy to deliver prescription drugs via a contract carrier and certain prescription drugs via unmanned aircraft systems. The shipment shall exclude controlled substances and sterile compounded preparations and comply with specified standards.^17,18 The rules require pharmacies to use common or contract carriers that maintain appropriate federal registration, ensure packaging that protects product integrity, document chain-of-custody steps, confirm a patient or patient agent is present at the selected delivery location, and require the pharmacist-in-charge to develop written policies for the service.^17,18 Board staff described the package as adding a definition of contract carrier, making pharmacies responsible for delivery problems by contract carriers, and applying existing standards, for example, United States Pharmacopeia and manufacturer requirements, to drone deliveries. The rules also require tamper-evident packaging; temperature control measures, such as temperature tags or insulated packaging, when necessary; and written procedures covering training, packaging, verification of the recipient and address, confidentiality, secure transfer, and recordkeeping.^17,18

Removal of Notary

The Texas State Board of Pharmacy adopted amendments to §291.17, concerning Inventory Requirements.²¹ The amendments remove inventory notarization requirements.

License Fees

The amendments to §295.5 and §291.6 increase pharmacy license fees and pharmacist license or renewal fees based on expected expenses resulting from appropriations made to TSBP under the General Appropriations Act of the 89^th Legislature.^22,23 The Board interprets Section 554.006(a) as authorizing the agency to adopt fees to cover the cost of administering Subtitle J, Title 3, Occupations Code, and to adopt rules for the proper administration and enforcement of the Act.²⁴

Pharmacist's Authority to Dispense Ivermectin

During its second special session, the 89th legislature voted to enact HB 25, which relates to a pharmacist's authority to dispense ivermectin without a prescription.^25,26 A pharmacist who dispenses ivermectin in a prudent manner is not criminally or civilly liable, nor subject to disciplinary action, for dispensing in accordance with standard procedures or protocols.^25,26 The law took effect on December 4, 2025, and authorizes pharmacists to act in accordance with any procedures issued by TSBP. The effective date is not contingent upon TSBP issuing procedures or adopting rules.^17,25,26

New Pharmacy Technician-to-Pharmacist Ratios

In May 2025, the TSBP adopted an important amendment to the rules governing pharmacy technician staffing ratios. Historically, Texas law imposed a maximum ratio of 1 on-site pharmacist to 6 pharmacy technicians, with up to 3 of those 6 being pharmacy technician trainees.²⁷ This ratio is intended to balance operational efficiency with patient safety, ensuring that pharmacists are not overwhelmed and can appropriately supervise non-pharmacist personnel.

The TSBP adopted rules allowing exemptions from the 1:6 technician-to-pharmacist ratio for central fill pharmacies that do not directly interact with patients.²⁸ For purposes of this subparagraph, patient-facing contact means any direct interaction between a pharmacy employee and a patient or patient's agent.²⁸

Fingerprint Check in the Texas Occupations Code

Texas Occupations Code, Section 602.2101 requires a fingerprint background check prior to a pharmacist license renewal, beginning with pharmacists whose licenses must be renewed by February 28, 2023.²⁹ This section requires a fingerprint background check for all current licensees and permit holders and requires those who completed a fingerprint requirement before June 1, 2015, to complete a new fingerprint background check. This is a one-time requirement.²⁹ The requirement began with pharmacy technicians and now expands to pharmacists. Reminders of the requirement will be included with the renewal notice sent 60 days before license expiration. Fingerprint information for pharmacists, technicians, trainees, and interns is located on the TSBP website.⁶ To complete the fingerprint session outside of the renewal period, email [email protected] with the license number, full name, and the request.

Texas Prescription Monitoring Program (PMP)

The Texas Prescription Monitoring Program (Texas PMP), also referred to as AWARxE, is managed by the Texas State Board of Pharmacy. It collects and monitors outpatient prescription data for all Schedule II, III, IV, and V controlled substances dispensed by a pharmacy in Texas. It also collects and monitors controlled substances for a Texas resident from a pharmacy located in another state.³⁰

The Texas PMP is a patient care tool that can be used to inform prescribing practices, as well as address prescription drug misuse and diversion. The number of states utilizing the program is increasing. Texas PMP shares prescription data with 36 other states and entities, enabling prescribers and pharmacists to track prescriptions dispensed outside Texas.³⁰ Pharmacists and prescribers (other than a veterinarian) are required to check the patient’s PMP history before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol 21 per section 481.0764 of the Texas Controlled Substances Act and section 315.15 of the Board rules.³¹

Recently adopted rule change summaries can be located at the following link:

https://www.pharmacy.texas.gov/Rules_Recent_Adopted_Changes.asp within the TSBP website.

This link shows an Infographic example of the integrated workflow, where "View Report" must be manually clicked for compliance:

https://www.pharmacy.texas.gov/news/imgs/integration.png

The Texas PMP allows prescribers and pharmacists to designate an unlimited number of delegates to access patient prescription data and generate reports on their behalf. Each individual must register as a separate user; however, all delegate queries are attributed to the prescriber or pharmacist who generates the report.²²

The Texas PMP can be accessed in several ways:

www.pharmacy.texas.gov/pmp

txpmp.org

The TSBP reminds licensed professionals of the PMP Mandatory Lookup Compliance in Integrated electronic health records.³¹ In some integrated pharmacy management systems, opening a patient record displays only a patient score rather than the full PMP report.³⁰ Viewing the patient score alone does not satisfy the mandatory PMP lookup requirement.³⁰ The pharmacist must manually initiate a report request by clicking on “View/Show Report” and accessing the full controlled substance history report for the patient to comply with the mandated PMP lookup requirement. Other integrated pharmacy management systems will load both the patient score and the full patient report. In this case, the pharmacist does not need to load the report separately to be compliant with the mandate.

Controlled Substances

Schedule II prescriptions must be dispensed within 30 days of issuance of the prescription.³² A practitioner may issue multiple written prescriptions authorizing a patient to receive up to a 90-day supply of a Schedule II controlled substance, provided the following conditions are met:

Each prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice;³³

The practitioner provides written instructions on each prescription, other than the first prescription if the practitioner intends for that prescription to be filled immediately, indicating the earliest date on which a pharmacy may dispense each prescription;³³ and,

The practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse.³³

Exception: Opioids for the treatment of acute pain. For the treatment of acute pain, as defined in §481.07636 of the TCSA, a practitioner may not issue a prescription for an opioid in an amount that exceeds a 10-day supply or provide for a refill of the opioid prescription.³⁴

Scam Communications

Scams involving individuals impersonating state agencies remain a serious issue. Scams are also becoming more sophisticated.^35,36 It is important to be aware of these types of scams and to know how to protect yourself and your personal data from them. Others associated with the pharmacy (owners, vendors, etc.) may also be targets of these scams. The most recent scam reports to TSBP indicate that telephone scammers are spoofing TSBP's phone number so the calls appear to originate directly from TSBP.³⁵ Scammers may also pose as TSBP staff by using a staff member's name and/or title. Scammers can seek several things. The most commonly reported scams involve scammers attempting to extort money from individuals, obtain drug wholesaler information, or extract information that could allow them to access drugs through a pharmacy's legitimate channels.³⁶

The TSBP does not request personal information in unsolicited phone calls or text messages. If suspicious documentation from an entity that appears to be TSBP is encountered, contact TSBP directly to confirm. Also, TSBP will NEVER request money or bank account information over the phone or via text.

Written Scam Example:

Scammers have used official-looking letterhead and some “true” information about TSBP (phone number, address) to lend this document a semblance of legitimacy.³⁷ The letter indicated that the license was suspended and instructed that the department be contacted to resolve the issue.³⁷

Telephone Scam Example:

A pharmacist received a call from an individual who identified themselves as an agent/officer with TSBP.³⁷ The pharmacist is told their license is going to be suspended because drugs with the pharmacist's name on them were found in a car and confiscated at the border.³⁷

The scammer then told the pharmacist to leave the pharmacy immediately so they could be notified of the alleged incident.³⁷ The scammer usually tells the pharmacist to go to a location that can receive faxes. In one instance, the pharmacist was told to go to a UPS store to receive a fax (the same example letter found on the TSBP website).³⁷ The scammers kept RPH on the phone for about 45 minutes while transferring them to various “agents.” After the faxed letter was received, the scammers began demanding money from the pharmacist, who identified the activity as suspicious and ended the call immediately.³⁷

What action should be taken if you receive a communication that you suspect is a scam involving an individual impersonating a state agency?

Call the State Board of Pharmacy directly to confirm legitimacy. Do not call a number on a letter or provided over the telephone.

Report information about scammers to the Texas Office of the Attorney General

Texas Office of the Attorney General

Consumer Protection Hotline: (800) 621-0508

Consumer Protection Website: https://www.texasattorneygeneral.gov/consumer-protection/common-scams

Pharmacy Technicians

The TSBP website includes links to the Pharmacy Technician Certification Board and the Pharmacy Technician Certification Exam, as the Board accepts the exam.³⁸ The exam changes include a greater focus on pharmacy law, order processing, and federal requirements, while reducing the emphasis on drug memorization.³⁹ Narrow-therapeutic-index medications have been removed from the exam. The exam places greater emphasis on Fraud, Waste, and Abuse, and on the Drug Supply Chain Security Act, and removes some alligation calculations and nonsterile compounding.

Pharmacy Benefit Management (PBM)

At least one Texas pharmacy has closed every week for the past two years.⁴⁰ Pharmacy benefit management agreements manage prescription drug benefits for insurers, employers, and government payers.⁴⁰ In May 2025, Texas Governor Greg Abbott signed SB 1236 to reform PBMs, aiming to protect local pharmacies from unfair audits, restrictive networks, and unfair contract changes.⁴¹ The legislation is intended to help protect Texas patients, pharmacies, and employers from some anti-competitive, anti-consumer practices.⁴¹ The law, which amends the Insurance Code, is effective September 1, 2025, and mandates that PBMs provide 90 days' notice for contract changes, require transparent identification cards, and restrict "clawbacks" of fees during audits for minor clerical errors.⁴¹ Pharmacies will not be reimbursed for drugs at a price below their actual cost. It encourages more transparent reporting of drug pricing and rebate data. It prohibits PBMs from retaliating against pharmacies for filing appeals.⁴¹

At a federal level, parallel legislation was undertaken. The Consolidated Appropriations Act was signed in January 2026 by President Trump.⁴² It includes PBM reforms in Medicare Part D, Medicare Advantage, and commercial markets.⁴² It contains requirements for rebate pass-through, enhanced disclosures, flat-fee service agreements, and enhanced federal oversight. It states that PBMs and affiliates shall not derive remuneration tied to the utilization of covered Part D drug, other than a ‘Flat Bona Fide Service Fee.’⁴² It includes enhanced oversight by the Secretary of the Department of Health and Human Services' Office of Inspector General regarding PBM agreements with manufacturers and drug program sponsors.⁴² Pharmacy benefit management fees paid by drug distribution chain members will be subject to review by the Secretary and the Office of the Inspector General. This results in broad implications for the prescription drug market.⁴²

Senate Bill 493 passed in the 2025 legislative session.⁴³ It aimed to eliminate pharmacy ‘gag’ clauses. Previously, pharmacy contracts often forbade pharmacists from voluntarily telling customers when their out-of-pocket costs from their insurance were higher than paying cash.⁴³ It ensures that pharmacists can inform patients and plan sponsors that a prescription drug, service, or benefit is less expensive when paid for with cash than when paid through insurance.⁴³ It is intended to enhance transparency and enable consumers to find the lowest possible price for their medical needs.⁴³

Common Violations

The Texas Health and Human Services Office of the Inspector General works with pharmacists to investigate and prevent fraud, waste, and abuse in Medicaid and the Children’s Health Insurance Program to minimize billing mistakes and ensure Texas tax dollars are used as intended.

The most common pharmacy violations observed in OIG investigations were found to be the following:⁴⁴

Dispensing incorrect quantities without authorization.

Refilling prescriptions without authorization.

Billing errors (e.g., billing for brand, dispensing generic).

Phantom billing for prescriptions never dispensed

Pharmacy Operations & Compliance (e.g., billing for a drug without an invoice supporting the purchase)

Summary

The practice of pharmacy continues to evolve, and the official pharmacy statutes and rules should always be consulted for comprehensive information relating to a particular statute or rule. The TSBP has implemented changes in Texas law that promote public health for Texas citizens and encourage innovative, multidisciplinary, and collaborative practices and education in the pharmacy and healthcare settings. Pharmacy team members contribute to this mission of prioritizing the health and safety of Texas citizens by learning and following Texas pharmacy statutes and rules.

References

Regulation Nation: What Industries Are Most Carefully Overseen? FindLaw. March 21, 2019. Accessed April 25, 2026. https://www.findlaw.com/legalblogs/small-business/regulation-nation-what-industries-are-most-carefully-overseen/

TEXAS STATE BOARD OF PHARMACY. Board of Pharmacy. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/consumer/broch9.asp#:~:text=The%20TSBP's%20responsibilities%20include:%20*%20Licensing%20pharmacists,*%20Open%20Meetings%20Act%20*%20Sunset%20Act

TEXAS STATE BOARD OF PHARMACY. Board Members. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/about/members/

Texas State Board of Pharmacy Board Rules. 22 TAC, Part 15. March 1, 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/files_pdf/tsbp%20rules_master%20file.pdf#:~:text=§281.1%20Objective%20and%20Scope,matter%20within%20the%20jurisdiction%20of

22 TAC §291.33

22 TAC §291.104

22 TAC 291.133

22 TAC §295.8

22 TAC §297.8

22 TAC §281.63

22 TAC §297.10

22 TAC §283.12

22 TAC §291.31

22 TAC §291.52

22 TAC §291.12

22 TAC §291.72

Texas State Board of Pharmacy. Memorandum. Rules adopted and proposed at the August 2025 Board Meeting. August 21, 2025. Accessed April 25, 2026. https://www.pharmacy.texas.gov/files_pdf/rule-memo/2025-08-August-Board-Meeting.pdf

Citizen Portal. Texas pharmacy board adopts rules allowing drug deliveries by drone with temperature, packaging and record requirements. July 28, 2025. Accessed April 25, 2026. https://citizenportal.ai/articles/6144816/Texas/Texas-pharmacy-board-adopts-rules-allowing-drug-deliveries-by-drone-with-temperature-packaging-and-record-requirements

22 TAC §291.9

22 TAC §291.12

22 TAC §291.17

22 TAC §295.5

22 TAC §291.6

Texas Occupations Code, §554.006(a)

TEXAS STATE BOARD OF PHARMACY. Newsroom. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/news/#:~:text=Recent%20Updates,-April%2025%2C%202026&text=During%20its%20second%20special%20session,any%20procedures%20issued%20by%20TSBP

Texas House Bill 25. 2025. Accessed April 25, 2026. https://legiscan.com/TX/bill/HB25/2025/X2

22 TAC §291.32 (d)(3)(A)

22 TAC §291.32 (d)(3)(B)

Texas State Board of Pharmacy. FAQs Fingerprints. Pharmacist Renewal. Accessed April 25, 2026. https://www.pharmacy.texas.gov/fingerprints/fingerprints-pharmacist-renewal.asp

Texas State Board of Pharmacy. Texas Prescription Monitoring Program. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/PMP/aware.asp

Texas State Board of Pharmacy. PMP Mandatory Lookup Compliance in Integrated EHRs. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/news/pmp-integration-compliance.asp

22 TAC §315.3(a)(4)

22 TAC §315.3(a)(3)

22 TAC §315.3(f)

Scam Alert Reminder. Texas State Board of Pharmacy. 2026. Accessed April 25, 2026. 2026. https://www.pharmacy.texas.gov/

Common scam targets. Texas State Board of Pharmacy. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/news/scams-info.asp

Scam Alert. Texas State Board of Pharmacy. 2026. Accessed April 25, 2026 https://www.pharmacy.texas.gov/news/scams.asp

Texas State Board of Pharmacy. Initial Application Pharmacy Technician. 2026. Accessed April 25, 2026. https://www.pharmacy.texas.gov/applicants/tech.asp#:~:text=To%20become%20a%20pharmacy%20technician%20in%20Texas%2C,(ExCPT)%20from%20the%20National%20Healthcareer%20Association%20(NHA)

Updated 2026 PTCB Syllabus: Key Changes You Should Know. PTCB Test Prep. March 13, 2026. Accessed April 25, 2026. https://ptcbtestprep.com/updated-2026-ptcb-syllabus-key-changes-you-should-know/

Texas Senate Bill 1236. Legiscan. September 1, 2025. Accessed April 25, 2026. https://legiscan.com/TX/text/SB1236/2025

PHARMACY WIN: Gov. Abbott Signs PBM Reform Bill into Law. Texas Pharmacy Association. May 28, 2025. Accessed April 25, 2026. https://www.texaspharmacy.org/news/702159/PHARMACY-WIN-Gov.-Abbott-Signs-PBM-Reform-Bill-into-Law.htm

Consolidated Appropriations Act. HR 7148. 119th Congress of the United States. January 3, 2026. Accessed April 25, 2026. https://www.congress.gov/119/bills/hr7148/BILLS-119hr7148enr.pdf

Senate Bill 493. Legiscan. September 1, 2025. Accessed April 25, 2026. https://legiscan.com/TX/bill/SB493/2025

OIG identifies common pharmacy violations. Office of the Inspector General Texas Health and Human Services. March 7, 2023. Accessed April 25, 2026. https://oig.hhs.texas.gov/about-us/news/oig-identifies-common-pharmacy-violations#:~:text=The%20Texas%20Health%20and%20Human%20Services%20Office,and%20not%20giving%20the%20medications%20to%20clients

DISCLAIMER

The information provided in this course is general in nature, and it is designed solely to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.

Healthcare professionals must consult their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures to follow. The information provided in this course does not replace those guidelines, protocols, and procedures, but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.

Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses is constantly changing. Any person taking this course understands that such a person must make an independent review of medication information before any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.

Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course or course material.

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