| |
| |
| |
|
|
AN ACT
|
|
|
relating to prohibited practices for certain health benefit plan |
|
|
issuers and pharmacy benefit managers. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Chapter 1369, Insurance Code, is amended by |
|
|
adding Subchapter L to read as follows: |
|
|
SUBCHAPTER L. AFFILIATED PROVIDERS |
|
|
Sec. 1369.551. DEFINITIONS. In this subchapter: |
|
|
(1) "Affiliated provider" means a pharmacy or durable |
|
|
medical equipment provider that directly, or indirectly through one |
|
|
or more intermediaries, controls, is controlled by, or is under |
|
|
common control with a health benefit plan issuer or pharmacy |
|
|
benefit manager. |
|
|
(2) "Health benefit plan" has the meaning assigned by |
|
|
Section 1369.251. |
|
|
(3) "Pharmacy benefit manager" has the meaning |
|
|
assigned by Section 4151.151. |
|
|
Sec. 1369.552. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER. |
|
|
Notwithstanding the definition of "health benefit plan" provided by |
|
|
Section 1369.551, this subchapter does not apply to an issuer or |
|
|
provider of health benefits under or a pharmacy benefit manager |
|
|
administering pharmacy benefits under: |
|
|
(1) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code; |
|
|
(2) the child health plan program under Chapter 62, |
|
|
Health and Safety Code; |
|
|
(3) the TRICARE military health system; |
|
|
(4) a basic coverage plan under Chapter 1551; |
|
|
(5) a basic plan under Chapter 1575; |
|
|
(6) a coverage plan under Chapter 1579; |
|
|
(7) a plan providing basic coverage under Chapter |
|
|
1601; or |
|
|
(8) a workers' compensation insurance policy or other |
|
|
form of providing medical benefits under Title 5, Labor Code. |
|
|
Sec. 1369.553. TRANSFER OR ACCEPTANCE OF CERTAIN RECORDS |
|
|
PROHIBITED. (a) In this section, "commercial purpose" does not |
|
|
include pharmacy reimbursement, formulary compliance, |
|
|
pharmaceutical care, utilization review by a health care provider, |
|
|
or a public health activity authorized by law. |
|
|
(b) A health benefit plan issuer or pharmacy benefit manager |
|
|
may not transfer to or receive from the issuer's or manager's |
|
|
affiliated provider a record containing patient- or |
|
|
prescriber-identifiable prescription information for a commercial |
|
|
purpose. |
|
|
Sec. 1369.554. PROHIBITION ON CERTAIN COMMUNICATIONS. (a) |
|
|
A health benefit plan issuer or pharmacy benefit manager may not |
|
|
steer or direct a patient to use the issuer's or manager's |
|
|
affiliated provider through any oral or written communication, |
|
|
including: |
|
|
(1) online messaging regarding the provider; or |
|
|
(2) patient- or prospective patient-specific |
|
|
advertising, marketing, or promotion of the provider. |
|
|
(b) This section does not prohibit a health benefit plan |
|
|
issuer or pharmacy benefit manager from including the issuer's or |
|
|
manager's affiliated provider in a patient or prospective patient |
|
|
communication, if the communication: |
|
|
(1) is regarding information about the cost or service |
|
|
provided by pharmacies or durable medical equipment providers in |
|
|
the network of a health benefit plan in which the patient or |
|
|
prospective patient is enrolled; and |
|
|
(2) includes accurate comparable information |
|
|
regarding pharmacies or durable medical equipment providers in the |
|
|
network that are not the issuer's or manager's affiliated |
|
|
providers. |
|
|
Sec. 1369.555. PROHIBITION ON CERTAIN REFERRALS AND |
|
|
SOLICITATIONS. (a) A health benefit plan issuer or pharmacy |
|
|
benefit manager may not require a patient to use the issuer's or |
|
|
manager's affiliated provider in order for the patient to receive |
|
|
the maximum benefit for the service under the patient's health |
|
|
benefit plan. |
|
|
(b) A health benefit plan issuer or pharmacy benefit manager |
|
|
may not offer or implement a health benefit plan that requires or |
|
|
induces a patient to use the issuer's or manager's affiliated |
|
|
provider, including by providing for reduced cost-sharing if the |
|
|
patient uses the affiliated provider. |
|
|
(c) A health benefit plan issuer or pharmacy benefit manager |
|
|
may not solicit a patient or prescriber to transfer a patient |
|
|
prescription to the issuer's or manager's affiliated provider. |
|
|
(d) A health benefit plan issuer or pharmacy benefit manager |
|
|
may not require a pharmacy or durable medical equipment provider |
|
|
that is not the issuer's or manager's affiliated provider to |
|
|
transfer a patient's prescription to the issuer's or manager's |
|
|
affiliated provider without the prior written consent of the |
|
|
patient. |
|
|
SECTION 2. Sections 1369.555(a) and (b), Insurance Code, as |
|
|
added by this Act, apply only to a health benefit plan delivered, |
|
|
issued for delivery, or renewed on or after the effective date of |
|
|
this Act. |
|
|
SECTION 3. This Act takes effect September 1, 2021. |
| |
| |
| |
______________________________ |
______________________________ |
| |
President of the Senate |
Speaker of the House |
| |
| |
|
|
I certify that H.B. No. 1919 was passed by the House on April |
|
|
29, 2021, by the following vote: Yeas 128, Nays 16, 2 present, not |
|
|
voting; and that the House concurred in Senate amendments to H.B. |
|
|
No. 1919 on May 28, 2021, by the following vote: Yeas 124, Nays 21, |
|
|
1 present, not voting. |
|
|
|
|
|
______________________________ |
|
|
Chief Clerk of the House |
| |
|
|
I certify that H.B. No. 1919 was passed by the Senate, with |
|
|
amendments, on May 24, 2021, by the following vote: Yeas 30, Nays |
|
|
0. |
|
|
|
|
|
______________________________ |
|
|
Secretary of the Senate |
|
|
APPROVED: __________________ |
|
|
Date |
|
|
|
|
|
__________________ |
|
|
Governor |