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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibited practices for certain health benefit plan |
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issuers and pharmacy benefit managers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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Section 1. Chapter 1369, Insurance Coded, is amended by |
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adding Subchapter K-1 to read as follows: |
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SUBCHAPTER K-1. AFFILIATED PHARMACIES |
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Sec. 1369.526. DEFINITIONS. In this subchapter: |
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(1) "Affiliated pharmacy" means a pharmacy that |
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directly, or indirectly through one or more intermediaries, |
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controls, is controlled by, or is under common control with a |
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pharmacy benefit manager. |
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(2) "Pharmacy benefit manager" has the meaning |
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assigned by Section 4151.151. |
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Sec. 1369.527. TRANSFER OR ACCEPTANCE OF CERTAIN RECORDS |
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PROHIBITED. (a) In this section, “commercial purpose” does not |
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include pharmacy reimbursement, formulary compliance, |
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pharmaceutical care, utilization review by a heath care provider, |
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or a public health activity authorized by law. |
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(b) A pharmacy benefit manager may not transfer to or |
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receive from an affiliated pharmacy a record containing patient- or |
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prescriber-identifiable prescription information for a commercial |
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purpose. |
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Sec. 1369.528. PROHIBITION ON CERTAIN COMMUNICATIONS. (a) |
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A health benefit plan issuer or pharmacy benefit manager may not |
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steer or direct a patient to use an affiliated pharmacy through any |
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oral or written communication, including: |
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(1) online messaging regarding the pharmacy; or |
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(2) patient- or prospective patient-specific |
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advertising, marketing, or promotion of the pharmacy. |
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(b) This section does not prohibit a health benefit plan |
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issuer or pharmacy benefit manager from including an affiliated |
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pharmacy in a patient or prospective patient communication, if the |
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communication: |
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(1) is regarding information about the cost or service |
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Provided by pharmacies in the network of a health benefit plan in |
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which the patient is enrolled; and |
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(2) includes accurate comparable information |
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regarding pharmacies in the network that are not affiliated |
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pharmacies. |
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Sec. 1369.529. PROHIBITION ON CERTAIN REFERRALS AND |
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SOLICITATIONS. (a) A health benefit plan issuer or pharmacy |
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benefit manager may not require a patient to use an affiliated |
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pharmacy in order for the patient to receive the maximum benefit for |
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the service under the patient’s health benefit plan. |
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(b) A health benefit plan issuer or pharmacy benefit manager |
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may not offer or implement a health benefit plan that requires or |
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induces a patient to use an affiliated pharmacy, including by |
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providing for reduced cost-sharing if the patient uses the |
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affiliated pharmacy. |
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(c) A health benefit plan issuer or pharmacy benefit manager |
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may not solicit a patient or prescriber to transfer a patient |
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prescription to an affiliated pharmacy. |
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(d) A health benefit plan issuer or pharmacy benefit manager |
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may not require a nonaffiliated pharmacy to transfer a patient’s |
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prescription to an affiliated pharmacy without the prior written |
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consent of the patient. |
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Section 2. This Act takes effect September 1, 2021. |