87R10443 TYPED
 
  By: Harris H.B. No. 1919
 
 
 
A BILL TO BE ENTITLED
 
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 Coded, is amended by
  adding Subchapter K-1 to read as follows:
  SUBCHAPTER K-1.  AFFILIATED PHARMACIES
         Sec. 1369.526.  DEFINITIONS.  In this subchapter:
               (1)  "Affiliated pharmacy" means a pharmacy that
  directly, or indirectly through one or more intermediaries,
  controls, is controlled by, or is under common control with a
  pharmacy benefit manager.
               (2)  "Pharmacy benefit manager" has the meaning
  assigned by Section 4151.151.
         Sec. 1369.527.  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 heath care provider,
  or a public health activity authorized by law.
         (b)  A pharmacy benefit manager may not transfer to or
  receive from an affiliated pharmacy a record containing patient- or
  prescriber-identifiable prescription information for a commercial
  purpose.
         Sec. 1369.528.  PROHIBITION ON CERTAIN COMMUNICATIONS.  (a)  
  A health benefit plan issuer or pharmacy benefit manager may not
  steer or direct a patient to use an affiliated pharmacy through any
  oral or written communication, including:
               (1)  online messaging regarding the pharmacy; or
               (2)  patient- or prospective patient-specific
  advertising, marketing, or promotion of the pharmacy.
         (b)  This section does not prohibit a health benefit plan
  issuer or pharmacy benefit manager from including an affiliated
  pharmacy in a patient or prospective patient communication, if the
  communication:
               (1)  is regarding information about the cost or service
  Provided by pharmacies in the network of a health benefit plan in
  which the patient is enrolled; and
               (2)  includes accurate comparable information
  regarding pharmacies in the network that are not affiliated
  pharmacies.
         Sec. 1369.529.  PROHIBITION ON CERTAIN REFERRALS AND
  SOLICITATIONS.  (a)  A health benefit plan issuer or pharmacy
  benefit manager may not require a patient to use an affiliated
  pharmacy 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 an affiliated pharmacy, including by
  providing for reduced cost-sharing if the patient uses the
  affiliated pharmacy.
         (c)  A health benefit plan issuer or pharmacy benefit manager
  may not solicit a patient or prescriber to transfer a patient
  prescription to an affiliated pharmacy.
         (d)  A health benefit plan issuer or pharmacy benefit manager
  may not require a nonaffiliated pharmacy to transfer a patient’s
  prescription to an affiliated pharmacy without the prior written
  consent of the patient.
         Section 2.  This Act takes effect September 1, 2021.