75R9435 SAW-F
By Van de Putte H.B. No. 3175
Substitute the following for H.B. No. 3175:
By Lewis of Tarrant C.S.H.B. No. 3175
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the provision of pharmaceutical services through
1-3 certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.52B, Insurance Code, is reenacted and
1-6 amended to read as follows:
1-7 Art. 21.52B. PHARMACEUTICAL SERVICES
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Health benefit plan" [insurance policy"] means an
1-10 individual, group, blanket, or franchise [insurance policy,]
1-11 insurance policy or insurance agreement, a [or] group hospital
1-12 service contract, or an evidence of coverage issued by a health
1-13 maintenance organization operating under the Texas Health
1-14 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
1-15 Code) that provides benefits for pharmaceutical services that are
1-16 necessary as a result of or to prevent an accident or sickness[,
1-17 but does not include evidence of coverage provided by a health
1-18 maintenance organization under the Texas Health Maintenance
1-19 Organization Act (Chapter 20A, Vernon's Texas Insurance Code)].
1-20 (2) "Pharmaceutical services" means services,
1-21 including dispensing prescription drugs, that are ordinarily and
1-22 customarily rendered by a pharmacy or pharmacist licensed to
1-23 practice pharmacy under the Texas Pharmacy Act (Article 4542a-1,
1-24 Vernon's Texas Civil Statutes).
2-1 (3) "Pharmacist" means a person licensed to practice
2-2 pharmacy under the Texas Pharmacy Act (Article 4542a-1, Vernon's
2-3 Texas Civil Statutes).
2-4 (4) "Pharmacy" means a facility licensed as a pharmacy
2-5 under the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil
2-6 Statutes).
2-7 (5) "Drugs" and "prescription drugs" have the meanings
2-8 assigned by Section 5, Texas Pharmacy Act (Article 4542a-1,
2-9 Vernon's Texas Civil Statutes).
2-10 [(6) "Managed care plan" means a health maintenance
2-11 organization, a preferred provider organization, or another
2-12 organization that, under a contract or other agreement entered into
2-13 with a participant in the plan:]
2-14 [(A) provides health care benefits, or arranges
2-15 for health care benefits to be provided, to a participant in the
2-16 plan; and]
2-17 [(B) requires or encourages those participants
2-18 to use health care providers designated by the plan.]
2-19 Sec. 2. PROHIBITED CONTRACTUAL PROVISIONS. (a) A health
2-20 benefit [insurance policy or managed care] plan that is delivered,
2-21 issued for delivery, or renewed or for which a contract or other
2-22 agreement is executed may not:
2-23 (1) prohibit or limit a person who is a beneficiary of
2-24 the plan [policy] from selecting a pharmacy or pharmacist of the
2-25 person's choice to be a provider under the plan [policy] to furnish
2-26 pharmaceutical services offered or provided by that plan [policy]
2-27 or interfere with that person's selection of a pharmacy or
3-1 pharmacist;
3-2 (2) deny a pharmacy or pharmacist the right to
3-3 participate as a contract provider under the [policy or] plan if
3-4 the pharmacy or pharmacist agrees to provide pharmaceutical
3-5 services that meet all terms and requirements of the plan and to
3-6 include the same administrative, financial, and professional
3-7 conditions that apply to pharmacies and pharmacists who have been
3-8 designated as providers under the [policy or] plan; or
3-9 (3) require a beneficiary of a [policy or a
3-10 participant in a] plan to obtain or request a specific quantity or
3-11 dosage supply of pharmaceutical products.
3-12 (b) Notwithstanding Subsection (a)(3) of this section, a
3-13 health benefit [insurance policy or managed care] plan may allow
3-14 the physician of a beneficiary [or participant] to prescribe drugs
3-15 in a quantity or dosage supply the physician determines appropriate
3-16 and that is in compliance with state and federal statutes.
3-17 (c) This section does not prohibit:
3-18 (1) a provision of a [policy or] plan from limiting
3-19 the quantity or dosage supply of pharmaceutical products for which
3-20 coverage is provided or providing financial incentives to encourage
3-21 the beneficiary [or participant] and the prescribing physician to
3-22 use a program that provides pharmaceutical products in quantities
3-23 that result in cost savings to the issuer of the health benefit
3-24 [insurance program or managed care] plan and the beneficiary [or
3-25 participant] if the provision applies equally to all designated
3-26 providers of pharmaceutical services under the [policy or] plan;
3-27 (2) a pharmacy card program that provides a means of
4-1 obtaining pharmaceutical services offered by the [policy or] plan
4-2 through all designated providers of pharmaceutical services; or
4-3 (3) a plan from establishing reasonable application
4-4 and recertification fees for a pharmacy which provides
4-5 pharmaceutical services as a contract provider under the plan,
4-6 provided that the [such] fees are uniformly charged to each
4-7 pharmacy under contract with [to] the plan.
4-8 Sec. 3. PROVISION VOID. A provision of a health benefit
4-9 [insurance policy or managed care] plan that is delivered, issued
4-10 for delivery, entered into, or renewed in this state that conflicts
4-11 with Section 2 of this article is void to the extent of the
4-12 conflict.
4-13 Sec. 4. CONSTRUCTION OF ARTICLE. This article does not
4-14 require a health benefit [insurance policy or managed care] plan to
4-15 provide pharmaceutical services.
4-16 Sec. 5. APPLICATION OF PROHIBITION. The provisions of
4-17 Section 2 of this article do not apply to a self-insured employee
4-18 benefit plan that is subject to the Employee Retirement Income
4-19 Security Act of 1974 (29 U.S.C. Section 1001, et seq.).
4-20 Sec. 6. SEVERABILITY. If any provision of this article or
4-21 its application to any person or circumstance is held invalid, the
4-22 invalidity does not affect other provisions or applications of the
4-23 article that can be given effect without the invalid provision or
4-24 application, and to this end the provisions of the article are
4-25 severable.
4-26 SECTION 2. Section 3, Chapter 182, Acts of the 72nd
4-27 Legislature, Regular Session, 1991, is repealed.
5-1 SECTION 3. This Act takes effect September 1, 1997, and
5-2 applies only to a health benefit plan that is delivered, issued for
5-3 delivery, or renewed on or after January 1, 1998. A health benefit
5-4 plan that is delivered, issued for delivery, or renewed before
5-5 January 1, 1998, is governed by the law as it existed immediately
5-6 before the effective date of this Act, and that law is continued in
5-7 effect for this purpose.
5-8 SECTION 4. The importance of this legislation and the
5-9 crowded condition of the calendars in both houses create an
5-10 emergency and an imperative public necessity that the
5-11 constitutional rule requiring bills to be read on three several
5-12 days in each house be suspended, and this rule is hereby suspended.