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A BILL TO BE ENTITLED
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AN ACT
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relating to limitations on use of certain pharmacy benefit |
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managers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter D, Chapter 4151, Insurance Code, is |
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amended by adding Section 4151.155 to read as follows: |
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Sec. 4151.155. PROHIBITION ON REQUIRING THE USE OF CERTAIN |
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PHARMACY BENEFIT MANAGERS. (a) If a health benefit plan has an |
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ownership or investment interest (which may be through equity, |
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debt, or other means) in a pharmacy benefit manager, then the health |
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benefit plan may not require the use of such pharmacy benefit |
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manager for the administering of pharmacy benefit services offered |
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under, or in conjunction with, the health benefit plan. |
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SECTION 2. Subchapter D, Chapter 4151, Insurance Code is |
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amended by adding Sec. 4151.156, Insurance Code, to read as |
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follows: |
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Sec. 4151.156. APPLICABILITY OF SECTION. (a) Section |
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4151.155 of this subchapter applies only to a health benefit plan |
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that provides benefits for medical or surgical expenses incurred as |
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a result of a health condition, accident, or sickness, including |
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individual, group, blanket, or group hospital service contract, or |
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an individual or group evidence of coverage or similar coverage |
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document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operation under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, the subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage through a health group cooperative |
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under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(4) a regional or local health care program operating |
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under Section 75.104, Health and Safety Code; |
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(5) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(6) a basic coverage plan under Chapter 1551; |
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(7) a basic plan under Chapter 1575; |
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(8) a coverage plan under Chapter 1579; and |
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(9) a plan providing basic coverage under Chapter |
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1601. |
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SECTION 3. Sections 4151.155 and 4151.156, Subchapter D, |
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Chapter 4151, Insurance Code as added by this Act, apply only to a |
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health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2024. |
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SECTION 4. This Act takes effect September 1, 2023. |