By Nelson S.B. No. 782
76R4031 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to disclosure requirements for certain information held by
1-3 pharmacists, pharmacies, and pharmacy benefit managers.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 5, Texas Pharmacy Act (Article 4542a-1,
1-6 Vernon's Texas Civil Statutes), is amended to read as follows:
1-7 Sec. 5. DEFINITIONS. In this Act, unless the context of its
1-8 use clearly indicates otherwise:
1-9 (1) "A.C.P.E." means the American Council on
1-10 Pharmaceutical Education.
1-11 (2) "Administer" means the direct application of a
1-12 prescription drug by injection, inhalation, ingestion, or any other
1-13 means to the body of a patient by:
1-14 (A) a practitioner, an authorized agent under
1-15 his supervision, or other person authorized by law; or
1-16 (B) the patient at the direction of a
1-17 practitioner.
1-18 (3) "Administrative Procedure Act" means Chapter 2001,
1-19 Government Code.
1-20 (4) "Board" means the Texas State Board of Pharmacy.
1-21 (5) "Class A pharmacy license" or "community pharmacy
1-22 license" means a license issued to a pharmacy dispensing drugs or
1-23 devices to the general public pursuant to a prescription drug
1-24 order.
2-1 (6) "Class B pharmacy license" or "nuclear pharmacy
2-2 license" means a license issued to a pharmacy dispensing or
2-3 providing radioactive drugs or devices for administration to an
2-4 ultimate user.
2-5 (7) "Class C pharmacy license" or "institutional
2-6 pharmacy license" means a license issued to a pharmacy located in a
2-7 hospital or other in-patient facility that is licensed under
2-8 Chapter 241 or 577, Health and Safety Code, [or Chapter 6, Texas
2-9 Mental Health Code (Article 5547-1 et seq., Vernon's Texas Civil
2-10 Statutes),] to a hospice in-patient facility that is licensed under
2-11 Chapter 142, Health and Safety Code, or to a pharmacy located in a
2-12 hospital maintained or operated by the state.
2-13 (8) "Class D pharmacy license" or "clinic pharmacy
2-14 license" means a license issued to a pharmacy dispensing a limited
2-15 type of drugs or devices pursuant to a prescription drug order.
2-16 (9) "Class E pharmacy license" or "nonresident
2-17 pharmacy license" means a license issued under this Act to a
2-18 pharmacy located in a state of the United States other than this
2-19 state whose primary business is to dispense a prescription drug or
2-20 device under a prescription drug order and to deliver the drug or
2-21 device to a patient, including a patient in this state, by the
2-22 United States mail, a common carrier, or a delivery service.
2-23 (10) "College of pharmacy" means a school, university,
2-24 or college of pharmacy that satisfies the accreditation standards
2-25 of A.C.P.E. as adopted by the board; or that has degree
2-26 requirements which meet the standards of accreditation set by the
2-27 board.
3-1 (11) "Compounding" means the preparation, mixing,
3-2 assembling, packaging, or labeling of a drug or device:
3-3 (A) as the result of a practitioner's
3-4 prescription drug order or initiative based on the
3-5 practitioner-patient-pharmacist relationship in the course of
3-6 professional practice;
3-7 (B) in anticipation of prescription drug orders
3-8 based on routine, regularly observed prescribing patterns; or
3-9 (C) for the purpose of or as an incident to
3-10 research, teaching, or chemical analysis and not for sale or
3-11 dispensing.
3-12 (12) "Confidential record" means any health-related
3-13 record that contains information that identifies an individual and
3-14 that is maintained by a pharmacy or pharmacist such as a patient
3-15 medication record, prescription drug order, or medication order.
3-16 (13) "Controlled substance" means a drug, immediate
3-17 precursor, or other substance listed in Schedules I-V or Penalty
3-18 Groups 1-4 of Chapter 481, Health and Safety Code, or a drug,
3-19 immediate precursor, or other substance included in Schedule I, II,
3-20 III, IV, or V of the Federal Comprehensive Drug Abuse Prevention
3-21 and Control Act of 1970 (21 U.S.C. Section 801 et seq.).
3-22 (14) "Controlled Substances Act" means Chapter 481,
3-23 Health and Safety Code, or the Federal Comprehensive Drug Abuse
3-24 Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.).
3-25 (15) "Dangerous drug" means any drug or device that is
3-26 not included in Penalty Groups 1-4 of the Controlled Substances Act
3-27 and that is unsafe for self-medication or any drug or device that
4-1 bears or is required to bear the legend:
4-2 (A) "Caution: federal law prohibits dispensing
4-3 without prescription"; or
4-4 (B) "Caution: federal law restricts this drug
4-5 to use by or on the order of a licensed veterinarian."
4-6 (16) "Dangerous Drug Act" means Chapter 483, Health
4-7 and Safety Code.
4-8 (17) "Deliver" or "delivery" means the actual,
4-9 constructive, or attempted transfer of a prescription drug or
4-10 device or controlled substance from one person to another, whether
4-11 or not for a consideration.
4-12 (18) "Designated agent" means:
4-13 (A) a licensed nurse, physician assistant,
4-14 pharmacist, or other individual designated by a practitioner, and
4-15 for whom the practitioner assumes legal responsibility, who
4-16 communicates prescription drug orders to a pharmacist;
4-17 (B) a licensed nurse, physician assistant, or
4-18 pharmacist employed in a health care facility to whom the
4-19 practitioner communicates a prescription drug order; or
4-20 (C) a registered nurse or physician assistant
4-21 authorized by a practitioner to carry out a prescription drug order
4-22 for dangerous drugs under Subdivision (5) or (6), Subsection (d),
4-23 Section 3.06, Medical Practice Act (Article 4495b, Vernon's Texas
4-24 Civil Statutes).
4-25 (19) "Device" means an instrument, apparatus,
4-26 implement, machine, contrivance, implant, in vitro reagent, or
4-27 other similar or related article, including any component part or
5-1 accessory, that is required under federal or state law to be
5-2 ordered or prescribed by a practitioner.
5-3 (20) "Dispense" means preparing, packaging,
5-4 compounding, or labeling for delivery a prescription drug or device
5-5 in the course of professional practice to an ultimate user or his
5-6 agent by or pursuant to the lawful order of a practitioner.
5-7 (21) "Distribute" means the delivery of a prescription
5-8 drug or device other than by administering or dispensing.
5-9 (22) "Drug" means:
5-10 (A) a substance recognized as drugs in the
5-11 current official United States Pharmacopoeia, official National
5-12 Formulary, official Homeopathic Pharmacopoeia, or other drug
5-13 compendium or any supplement to any of them;
5-14 (B) a substance intended for use in the
5-15 diagnosis, cure, mitigation, treatment, or prevention of disease in
5-16 man or other animals;
5-17 (C) a substance, other than food, intended to
5-18 affect the structure or any function of the body of man or other
5-19 animals;
5-20 (D) a substance intended for use as a component
5-21 of any articles specified in Paragraph (A), (B), or (C) of this
5-22 subdivision;
5-23 (E) a dangerous drug; or
5-24 (F) a controlled substance.
5-25 (23) "Drug regimen review" includes the following
5-26 activities:
5-27 (A) evaluation of prescription drug or
6-1 medication orders and patient medication records for:
6-2 (i) known allergies;
6-3 (ii) rational therapy-contraindications;
6-4 (iii) reasonable dose and route of
6-5 administration; and
6-6 (iv) reasonable directions for use;
6-7 (B) evaluation of prescription drug or
6-8 medication orders and patient medication records for duplication of
6-9 therapy;
6-10 (C) evaluation of prescription drug or
6-11 medication orders and patient medication records for:
6-12 (i) drug-drug interactions;
6-13 (ii) drug-food interactions;
6-14 (iii) drug-disease interactions;
6-15 (iv) adverse drug reactions; and
6-16 (D) evaluation of prescription drug and
6-17 medication orders and patient medication records for proper
6-18 utilization, including overutilization or underutilization.
6-19 (24) "Internship" means a practical experience program
6-20 that is approved by the board.
6-21 (25) "Label" means written, printed, or graphic matter
6-22 on the immediate container of a drug or device.
6-23 (26) "Labeling" means the process of affixing a label
6-24 including all information required by federal and state law or
6-25 regulation to any drug or device container. The term does not
6-26 include the labeling by a manufacturer, packer, or distributor of a
6-27 nonprescription drug or commercially packaged prescription drug or
7-1 device, or unit dose packaging.
7-2 (27) "Manufacturing" means the production,
7-3 preparation, propagation, conversion, or processing of a drug or
7-4 device, either directly or indirectly, by extraction from
7-5 substances of natural origin or independently by means of chemical
7-6 or biological synthesis and includes any packaging or repackaging
7-7 of the substances or labeling or relabeling of the container and
7-8 the promotion and marketing of such drugs or devices.
7-9 Manufacturing also includes the preparation and promotion of
7-10 commercially available products from bulk compounds for resale by
7-11 pharmacies, practitioners, or other persons but does not include
7-12 compounding.
7-13 (28) "Medication order" means an order from a
7-14 practitioner or a practitioner's designated agent for
7-15 administration of a drug or device.
7-16 (29) "Nonprescription drug" means a nonnarcotic drug
7-17 or device that may be sold without a prescription and that is
7-18 labeled and packaged in compliance with applicable state or federal
7-19 law.
7-20 (30) "Patient counseling" means the communication by
7-21 the pharmacist of information, as specified in the rules of the
7-22 board, to the patient or caregiver, in order to improve therapy by
7-23 ensuring proper use of drugs and devices.
7-24 (31) "Person" means an individual, corporation,
7-25 government or governmental subdivision or agency, business trust,
7-26 estate, trust, partnership, association, or any other legal entity.
7-27 (32) "Pharmaceutical care" is the provision of drug
8-1 therapy and other pharmaceutical services defined in the rules of
8-2 the board and intended to assist in the cure or prevention of a
8-3 disease, elimination or reduction of a patient's symptoms, or
8-4 arresting or slowing of a disease process.
8-5 (33) "Pharmacist" means a person licensed by the board
8-6 to practice pharmacy.
8-7 (34) "Pharmacist-in-charge" means the pharmacist
8-8 designated on a pharmacy license as the pharmacist who has the
8-9 authority or responsibility for a pharmacy's compliance with laws
8-10 and rules pertaining to the practice of pharmacy.
8-11 (35) "Pharmacist-intern" means an undergraduate
8-12 student enrolled in the professional sequence of a college of
8-13 pharmacy approved by the board and participating in a school-based,
8-14 board-approved internship program or a graduate of a college of
8-15 pharmacy who is participating in a board-approved internship.
8-16 (36) "Pharmacy" means a facility at which prescription
8-17 drug or medication orders are received, processed, or dispensed
8-18 under this Act, the Dangerous Drug Act, or the Controlled
8-19 Substances Act. The term does not include a narcotic drug
8-20 treatment program that is regulated by Chapter 466, Health and
8-21 Safety Code.
8-22 (37) "Pharmacy benefit manager" has the meaning
8-23 assigned by Section 1, Article 21.07-6, Insurance Code.
8-24 (38) "Pharmacy technician" means an individual
8-25 employed by a pharmacy whose responsibility is to provide technical
8-26 services that do not require professional judgment regarding the
8-27 preparation and distribution of drugs and who works under the
9-1 direct supervision of and is responsible to a pharmacist.
9-2 (39) [(38)] "Practice of pharmacy" means:
9-3 (A) provision of those acts or services
9-4 necessary to provide pharmaceutical care;
9-5 (B) interpretation and evaluation of
9-6 prescription drug orders or medication orders;
9-7 (C) participation in drug and device selection
9-8 as authorized by law, drug administration, drug regimen review, or
9-9 drug or drug-related research;
9-10 (D) provision of patient counseling;
9-11 (E) responsibility for:
9-12 (i) dispensing of prescription drug orders
9-13 or distribution of medication orders;
9-14 (ii) compounding and labeling of drugs and
9-15 devices, except labeling by a manufacturer, repackager, or
9-16 distributor of nonprescription drugs and commercially packaged
9-17 prescription drugs and devices;
9-18 (iii) proper and safe storage of drugs and
9-19 devices; or
9-20 (iv) maintenance of proper records for
9-21 drugs and devices;
9-22 (F) performance of a specific act of drug
9-23 therapy management for a patient delegated to a pharmacist by a
9-24 written protocol from a physician licensed in this state in
9-25 compliance with the Medical Practice Act (Article 4495b, Vernon's
9-26 Texas Civil Statutes); or
9-27 (G) administration of immunizations and
10-1 vaccinations under a physician's written protocol.
10-2 (40) [(39)] "Practitioner" means:
10-3 (A) a physician, dentist, podiatrist,
10-4 veterinarian, or other person licensed or registered to prescribe,
10-5 distribute, administer, or dispense a prescription drug or device
10-6 in the course of professional practice in this state;
10-7 (B) a person licensed by another state in a
10-8 health field in which, under Texas law, licensees in this state may
10-9 legally prescribe dangerous drugs or a person practicing in another
10-10 state and licensed by another state as a physician, dentist,
10-11 veterinarian, or podiatrist, having a current Federal Drug
10-12 Enforcement Administration registration number, and who may legally
10-13 prescribe Schedule II, III, IV, or V controlled substances in such
10-14 other state; or
10-15 (C) a person licensed in the Dominion of Canada
10-16 or the United Mexican States in a health field in which, under the
10-17 laws of this state, a licensee may legally prescribe dangerous
10-18 drugs. "Practitioner" does not include a person licensed under
10-19 this Act.
10-20 (41) [(40)] "Preceptor" means a pharmacist licensed in
10-21 this state to practice pharmacy who meets the preceptor
10-22 requirements specified by rule and who is certified by the board to
10-23 supervise and be responsible for the activities and functions of a
10-24 pharmacist-intern in the internship program.
10-25 (42) [(41)] "Prescription drug" means:
10-26 (A) a substance for which federal or state law
10-27 requires a prescription before it may be legally dispensed to the
11-1 public;
11-2 (B) a drug or device that under federal law is
11-3 required, prior to being dispensed or delivered, to be labeled with
11-4 either of the following statements:
11-5 (i) "Caution: federal law prohibits
11-6 dispensing without prescription"; or
11-7 (ii) "Caution: federal law restricts this
11-8 drug to use by or on the order of a licensed veterinarian"; or
11-9 (C) a drug or device that is required by any
11-10 applicable federal or state law or regulation to be dispensed on
11-11 prescription only or is restricted to use by a practitioner only.
11-12 (43) [(42)] "Prescription drug order" means:
11-13 (A) an order from a practitioner or a
11-14 practitioner's designated agent to a pharmacist for a drug or
11-15 device to be dispensed; or
11-16 (B) an order pursuant to Subdivision (5) or (6),
11-17 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
11-18 Vernon's Texas Civil Statutes).
11-19 (44) [(43)] "Prospective drug use review" means a
11-20 review of the patient's drug therapy and prescription drug order or
11-21 medication order, as defined in the rules of the board, prior to
11-22 dispensing or distributing the drug.
11-23 (45) [(44)] "Provide" means to supply one or more unit
11-24 doses of a nonprescription drug or dangerous drug to a patient.
11-25 (46) [(45)] "Radioactive drug" means a drug that
11-26 exhibits spontaneous disintegration of unstable nuclei with the
11-27 emission of nuclear particles or photons, including any
12-1 nonradioactive reagent kit or nuclide generator that is intended to
12-2 be used in the preparation of any such substance.
12-3 (47) [(46)] "Substitution" means the dispensing of a
12-4 drug or a brand of drug other than that which is ordered or
12-5 prescribed.
12-6 (48) [(47)] "Texas trade association" means a
12-7 nonprofit, cooperative association of business or professional
12-8 competitors in this state whose purpose is to assist its members,
12-9 industry, or profession and whose members have joined voluntarily.
12-10 (49) [(48)] "Ultimate user" means a person who has
12-11 obtained and possesses a prescription drug or device for the
12-12 person's own use or for the use of a member of the person's
12-13 household or for administering to an animal owned by the person or
12-14 by a member of the person's household.
12-15 (50) [(49)] "Unit dose packaging" means the ordered
12-16 amount of drug in a dosage form ready for administration to a
12-17 particular patient, by the prescribed route at the prescribed time,
12-18 and properly labeled with name, strength, and expiration date of
12-19 the drug.
12-20 (51) [(50)] "Written protocol" means a physician's
12-21 order, standing medical order, standing delegation order, or other
12-22 order or protocol as defined by rule of the Texas State Board of
12-23 Medical Examiners under the Medical Practice Act (Article 4495b,
12-24 Vernon's Texas Civil Statutes).
12-25 SECTION 2. The Texas Pharmacy Act (Article 4542a-1, Vernon's
12-26 Texas Civil Statutes) is amended by adding Sections 42-44 to read
12-27 as follows:
13-1 Sec. 42. DISCLOSURE OF FINANCIAL INCENTIVES REQUIRED. Each
13-2 pharmacist, pharmacy, and pharmacy benefit manager shall disclose
13-3 to the board in the manner provided by rule by the board any
13-4 financial incentive or other compensation paid or offered to the
13-5 pharmacist, pharmacy, and pharmacy benefit manager by a
13-6 pharmaceutical company.
13-7 Sec. 43. LIMITATIONS ON ACCESS TO CERTAIN PATIENT HEALTH
13-8 INFORMATION. (a) In this section, "patient health information"
13-9 means any confidential record and any other information compiled
13-10 during the course of patient treatment that could reasonably be
13-11 used to determine the identity of a specific patient, including:
13-12 (1) a medical record;
13-13 (2) genetic test information;
13-14 (3) clinical research records;
13-15 (4) mental health therapy notes; and
13-16 (5) prescription records.
13-17 (b) Each pharmacy and pharmacist shall ensure that patient
13-18 health information is maintained in a secure environment and that
13-19 access to that information is restricted to persons with legitimate
13-20 reasons for that access. The board by rule shall adopt guidelines
13-21 regarding access to patient health information regarding
13-22 pharmaceutical records by persons regulated under this Act and by
13-23 pharmacy benefit managers.
13-24 (c) This section does not supersede or otherwise affect
13-25 Section 40C of this Act or any requirement regarding
13-26 confidentiality of personal information regarding a patient that is
13-27 established under another law of this state or a federal law.
14-1 Sec. 44. PROHIBITED ACTS; EXCEPTIONS. (a) A person subject
14-2 to regulation under this Act may not sell, share, or use, for
14-3 marketing purposes, a list of patients that contains information
14-4 through which the identity of individual patients is disclosed.
14-5 (b) Subsection (a) of this section specifically prohibits a
14-6 person subject to regulation under this Act from selling, sharing,
14-7 or using a list of patients who have certain diagnoses or use
14-8 certain types of drugs in order to solicit an individual patient to
14-9 use another type or brand of drugs.
14-10 (c) A person subject to regulation under this Act may not
14-11 waive a prohibition created under this section by requesting or
14-12 requiring a patient to sign a consent form authorizing the
14-13 disclosure.
14-14 (d) This section does not prohibit a release of information
14-15 authorized under Section 40C of this Act.
14-16 (e) This section does not prohibit:
14-17 (1) general advertising about a specific
14-18 pharmaceutical product or service;
14-19 (2) a person from requesting and receiving information
14-20 regarding a specific pharmaceutical product or service;
14-21 (3) a person from requesting and receiving
14-22 information regarding the person's own records or claims, or those
14-23 regarding the person's dependent; or
14-24 (4) a pharmacist from providing information regarding
14-25 a specific pharmaceutical product or service to an individual
14-26 patient of that pharmacist in the course of providing patient
14-27 counseling.
15-1 (f) In addition to any other penalty provided by law, a
15-2 person regulated under this Act who violates this section commits
15-3 an act that constitutes a ground for appropriate disciplinary
15-4 action by the board under this Act.
15-5 SECTION 3. Section 1, Article 21.07-6, Insurance Code, is
15-6 amended by amending Subdivision (1) and by adding Subdivision (9)
15-7 to read as follows:
15-8 (1) "Administrator" means a person who collects
15-9 premiums or contributions from or who adjusts or settles claims in
15-10 connection with life, health, and accident benefits, including
15-11 pharmacy benefits, or annuities for residents of this state but
15-12 does not include:
15-13 (A) an employer on behalf of its employees or
15-14 the employees of one or more subsidiaries or affiliated
15-15 corporations of the employer;
15-16 (B) a union on behalf of its members;
15-17 (C) an insurance company or a group hospital
15-18 service corporation subject to Chapter 20 of this code with respect
15-19 to a policy lawfully issued and delivered by it in and under the
15-20 law of a state in which the insurer was authorized to do an
15-21 insurance business;
15-22 (D) a health maintenance organization that is
15-23 authorized to operate in this state under the Texas Health
15-24 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
15-25 Code), with respect to any activity that is specifically regulated
15-26 under that Act;
15-27 (E) an agent licensed under Article 21.07 or
16-1 Chapter 213, Acts of the 54th Legislature, Regular Session, 1955
16-2 (Article 21.07-1, Vernon's Texas Insurance Code), who is acting
16-3 under appointment on behalf of an insurance company authorized to
16-4 do business in this state and within the customary scope and duties
16-5 of the insurance agent's authority as an agent and who receives
16-6 commissions as an agent;
16-7 (F) a creditor who is acting on behalf of its
16-8 debtors with respect to insurance that covers a debt between the
16-9 creditor and its debtor so long as only the functions of a group
16-10 policyholder or creditor are performed;
16-11 (G) a trust established in conformity with 29
16-12 U.S.C. Section 186 and the trustees and employees who are acting
16-13 under the trust;
16-14 (H) a trust that is exempt from taxation under
16-15 Section 501(a) of the Internal Revenue Code of 1986 and the
16-16 trustees and employees acting under the trust, or a custodian and
16-17 the custodian's agents and employees who are acting pursuant to a
16-18 custodian account that complies with Section 401(f), Internal
16-19 Revenue Code of 1986;
16-20 (I) a bank, credit union, savings and loan
16-21 association, or other financial institution that is subject to
16-22 supervision or examination under federal or state law by federal or
16-23 state regulatory authorities so long as that institution is
16-24 performing only those functions for which it holds a license under
16-25 federal or state law;
16-26 (J) a company that advances and collects a
16-27 premium or charge from its credit card holders on their
17-1 authorization, if the company does not adjust or settle claims and
17-2 acts only in the company's debtor-creditor relationship with its
17-3 credit card holders;
17-4 (K) a person who adjusts or settles claims in
17-5 the normal course of his practice or employment as a licensed
17-6 attorney and who does not collect any premium or charge in
17-7 connection with life, health, or accident benefits, including
17-8 pharmacy benefits, or annuities;
17-9 (L) an adjuster licensed by the commissioner, if
17-10 the adjuster is engaged in the performance of his powers and duties
17-11 as an adjuster within the scope of his license;
17-12 (M) a person who provides technical, advisory,
17-13 utilization review, precertification, or consulting services to an
17-14 insurer, plan, or plan sponsor and who does not make any management
17-15 or discretionary decisions on behalf of an insurer, plan, or plan
17-16 sponsor;
17-17 (N) an attorney in fact for a Lloyd's operating
17-18 under Chapter 18 of this code or a reciprocal or interinsurance
17-19 exchange operating under Chapter 19 of this code if acting in the
17-20 capacity of attorney in fact under the applicable chapter;
17-21 (O) a municipality that is self-insured or a
17-22 joint fund, risk management pool, or a self-insurance pool composed
17-23 of political subdivisions of this state that participate in a fund
17-24 or pool through interlocal agreements and any nonprofit
17-25 administrative agency or governing body or any nonprofit entity
17-26 that acts solely on behalf of a fund, pool, agency, or body or any
17-27 other funds, pools, agencies, or bodies that are established
18-1 pursuant to or for the purpose of implementing an interlocal
18-2 governmental agreement;
18-3 (P) a self-insured political subdivision;
18-4 (Q) a plan under which insurance benefits are
18-5 provided exclusively by a carrier licensed to do business in this
18-6 state and the administrator of the plan is either:
18-7 (i) a full-time employee of the plan's
18-8 organizing or sponsoring association, trust, or other entity; or
18-9 (ii) the trustee or trustees of the
18-10 organizing or sponsoring trust; or
18-11 (R) a parent of a wholly owned direct or
18-12 indirect subsidiary insurer licensed to do business in this state
18-13 or a wholly owned direct or indirect subsidiary insurer that is a
18-14 part of the parent's holding company system that, only on behalf of
18-15 itself or its affiliated insurers:
18-16 (i) collects premiums or contributions, if
18-17 the parent or subsidiary insurer prepares only billing statements,
18-18 places those statements in the United States mail, and causes all
18-19 collected premiums to be deposited directly in a depository account
18-20 of the particular affiliated insurer, and the services rendered by
18-21 the parent or subsidiary are performed under an agreement regulated
18-22 and approved under Article 21.49-1 of this code or a similar
18-23 statute of the domiciliary state if the parent or subsidiary is a
18-24 foreign insurer doing business in this state; or
18-25 (ii) furnishes proof-of-loss forms,
18-26 reviews claims, determines the amount of the liability for those
18-27 claims, and negotiates settlements, but pays claims only from the
19-1 funds of the particular subsidiary by checks or drafts of that
19-2 subsidiary and the services rendered by the parent or subsidiary
19-3 are performed under an agreement regulated and approved under
19-4 Article 21.49-1 of this code or a similar statute of the
19-5 domiciliary state if the parent or subsidiary is a foreign insurer
19-6 doing business in this state.
19-7 (9) "Pharmacy benefit manager" means a person who
19-8 administers benefits provided under a health benefit plan that
19-9 relate to pharmaceutical services provided by a pharmacist or a
19-10 pharmacy, including:
19-11 (A) performing a utilization review regarding
19-12 prescription practices and dispensing of controlled substances;
19-13 (B) determining the extent of prescription
19-14 coverage under a health benefit plan; and
19-15 (C) determining which drugs are included in a
19-16 formulary used by a health benefit plan.
19-17 SECTION 4. Article 21.07-6, Insurance Code, is amended by
19-18 adding Section 25 to read as follows:
19-19 Sec. 25. APPLICATION TO PHARMACY BENEFIT MANAGERS;
19-20 DISCLOSURE OF CERTAIN PATIENT INFORMATION PROHIBITED. (a) A
19-21 person may not operate as a pharmacy benefit manager in this state
19-22 unless the person holds a certificate of authority issued under
19-23 this article to act as an administrator.
19-24 (b) An administrator who operates as a pharmacy benefit
19-25 manager may not disclose to an employer contracting with the
19-26 administrator under an employer plan information in the possession
19-27 of the administrator or to which the administrator has access that
20-1 was compiled during the course of treatment of a patient who is an
20-2 employee or dependent of an employee and that could reasonably be
20-3 used to determine the identity of the patient, including:
20-4 (1) a medical record;
20-5 (2) genetic test information;
20-6 (3) clinical research records;
20-7 (4) mental health therapy notes; and
20-8 (5) prescription records.
20-9 SECTION 5. This Act takes effect September 1, 1999.
20-10 SECTION 6. The importance of this legislation and the
20-11 crowded condition of the calendars in both houses create an
20-12 emergency and an imperative public necessity that the
20-13 constitutional rule requiring bills to be read on three several
20-14 days in each house be suspended, and this rule is hereby suspended.