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A BILL TO BE ENTITLED
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AN ACT
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relating to patient choice in the dispensing of |
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clinician-administered drugs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 1369, Insurance Code, is |
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amended by adding Section 1369.0042 to read as follows: |
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Sec. 1369.0042. PROHIBITION AGAINST LIMITING PATIENT |
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CHOICE WITH CLINICIAN-ADMINISTERED DRUGS. (a) In this section: |
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(1) "Administer" means to directly apply a drug to the |
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body of a patient by injection, inhalation, ingestion, or any other |
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means. |
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(2) "Clinician-administered drug" means an outpatient |
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prescription drug other than a vaccine that: |
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(A) cannot reasonably be self-administered by |
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the patient to whom the drug is prescribed or by an individual |
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assisting the patient with the self-administration; and |
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(B) is typically administered: |
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(i) by a physician or other health care |
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provider authorized under the laws of this state to administer the |
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drug, including when acting under a physician's delegation and |
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supervision; and |
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(ii) in a physician's office, hospital |
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outpatient infusion center, or other clinical setting. |
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(3) "Physician" means an individual licensed to |
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practice medicine in this state. |
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(4) "Health care provider" means an individual who is |
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licensed, certified, or otherwise authorized to provide health care |
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services in this state. |
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(b) An individual or group accident and health insurance |
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policy, contract, or agreement governed by the laws of this state |
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may not: |
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(1) require clinician-administered drugs to be |
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dispensed by a pharmacy selected by the health plan; |
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(2) if a clinician-administered drug is otherwise |
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covered, limit or exclude coverage for such drugs when not |
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dispensed by a pharmacy selected by the health plan; |
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(3) reimburse at a lesser amount |
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clinician-administered drugs dispensed by a pharmacy not selected |
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by the health plan; or |
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(4) require that an enrollee covered under such a |
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policy, contract, or agreement pay an additional fee, higher copay, |
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higher coinsurance, second copay, second coinsurance, or any other |
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form of price increase for clinician-administered drugs when not |
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dispensed by a pharmacy selected by the health plan. |
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(c) Nothing in this section may be construed as: |
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(1) authorizing a person to administer a drug when |
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otherwise prohibited under the laws of this state or federal law; or |
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(2) modifying drug administration requirements under |
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the laws of this state, including any requirements related to |
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delegation and supervision of drug administration. |
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SECTION 2. This Act takes effect September 1, 2021. |