Bill not drafted by TLC or Senate E&E.
Line and page numbers may not match official copy.
By Van de Putte H.B. No. 3175
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to policies of insurance providing pharmaceutical
1-3 services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.52B, Texas Insurance Code, is amended
1-6 as follows:
1-7 Art. 21.52B. Pharmaceutical Services
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Health insurance policy" means an individual,
1-10 group, blanket, or franchise insurance policy, insurance policy or
1-11 agreement, or group hospital service contract that provides
1-12 benefits for pharmaceutical services that are necessary as a result
1-13 of or to prevent an accident or sickness. [but does not include
1-14 evidence of coverage provided by a health maintenance organization
1-15 under the Texas Health Maintenance Organization Act (Chapter 20A,
1-16 Vernon's Texas Insurance Code).]
1-17 (2) "Pharmaceutical services" means services,
1-18 including dispensing prescription drugs, that are ordinarily and
1-19 customarily rendered by a pharmacy or pharmacist licensed to
1-20 practice pharmacy under the Texas Pharmacy Act (Article 4542a-1,
1-21 Vernon's Texas Civil Statutes).
1-22 (3) "Pharmacist" means a person licensed to practice
1-23 pharmacy under the Texas Pharmacy Act (Article 4542a-1, Vernon's
1-24 Texas Civil Statutes).
2-1 (4) "Pharmacy" means a facility licensed as a pharmacy
2-2 under the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil
2-3 Statutes).
2-4 (5) "Drugs" and "prescription drugs" have the meanings
2-5 assigned by Section 5, Texas Pharmacy Act (Article 4542-1, Vernon's
2-6 Texas Civil Statutes).
2-7 [(6) "Managed care plan" means a health maintenance
2-8 organization, a preferred-provider organization, or another
2-9 organization that, under a contract or other agreement entered into
2-10 with a participant in the plan:]
2-11 [(A) provides health care benefits, or arranges
2-12 for health care benefits to be provided, to a participant in the
2-13 plan; and]
2-14 [(B) requires or encourages those participants
2-15 to sue health care providers designated by the plan.]
2-16 Sec. 2. (a) A health insurance policy [or managed care
2-17 plan] that is delivered, issued for delivery, or renewed or for
2-18 which a contract or other agreement is executed may not:
2-19 (1) prohibit or limit a person who is a beneficiary of
2-20 the policy from selecting a pharmacy or pharmacist of the person's
2-21 choice to be a provider under the policy to furnish pharmaceutical
2-22 services offered or provided by that policy or interfere with that
2-23 person's selection of a pharmacy or pharmacist;
2-24 (2) deny a pharmacy or pharmacist the right to
2-25 participate as a contract provider under the policy [or plan] if
2-26 the pharmacy or pharmacist agrees to provide pharmaceutical
2-27 services that meet all terms and requirements and to include the
2-28 same administrative, financial, and professional conditions that
2-29 apply to pharmacies and pharmacists who have been designated as
2-30 providers under the policy [or plan]; or
3-1 (3) require a beneficiary of a policy [or a
3-2 participant in a plan] to obtain or request a specific quantity or
3-3 dosage supply of pharmaceutical products.
3-4 (b) Notwithstanding Subsection (a)(3) of this section, a
3-5 health insurance policy [or managed care plan] may allow the
3-6 physician of a beneficiary [or participant] to prescribe drugs in a
3-7 quantity or dosage supply the physician determines appropriate and
3-8 that is in compliance with state and federal statutes.
3-9 (c) This section does not prohibit:
3-10 (1) a provision of a policy [or plan] from limiting
3-11 the quantity or dosage supply of pharmaceutical products for which
3-12 coverage is provided or providing financial incentives to encourage
3-13 the beneficiary or participant and the prescribing physician to use
3-14 a program that provides pharmaceutical products in quantities that
3-15 result in cost savings to the insurance program [or managed care
3-16 plan] and the beneficiary [or participant] if the provision applied
3-17 equally to all designated providers of pharmaceutical services
3-18 under the policy; [or plan;]
3-19 (2) a pharmacy card program that provides a means of
3-20 obtaining pharmaceutical services offered by the policy [or plan]
3-21 through all designated providers of pharmaceutical services; or
3-22 (3) a policy [plan] from establishing reasonable
3-23 application and recertification fees for a pharmacy which provides
3-24 pharmaceutical services as a [contract] provider under the [plan]
3-25 policy, provided that such fees are uniformly charged to each
3-26 pharmacy under the policy [contract to the plan].
3-27 Sec. 3. PROVISION VOID. A provision of a health insurance
3-28 policy [or managed care plan] that is delivered, issued for
3-29 delivery, entered into, or renewed in this state that conflicts
3-30 with Section 2 of this article is void to the extent of the
4-1 conflict.
4-2 Sec. 4. CONSTRUCTION OF ARTICLE. This article does not
4-3 require a health insurance policy [or managed care plan] to provide
4-4 pharmaceutical services.
4-5 Sec. 5. APPLICATION OF PROHIBITION. The provisions of
4-6 Section 2 of this article do not apply to a self-insured employee
4-7 benefit plan that is subject to the Employee Retirement Income
4-8 Security Act of 1974 (29 U.S.C. Section 1001, et seq.).
4-9 SECTION 2. The importance of this legislation and the
4-10 crowded condition of the calendars in both houses create an
4-11 emergency and an imperative public necessity that the
4-12 constitutional rule requiring bills to be read on three several
4-13 days in each house be suspended, and this rule is hereby suspended.