87R6580 JES-F
 
  By: Schwertner S.B. No. 727
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to certain prohibited practices by pharmacy benefit
  managers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 4151.151, Insurance Code, is amended to
  read as follows:
         Sec. 4151.151.  DEFINITIONS [DEFINITION].  In this
  subchapter:
               (1)  "Affiliated pharmacist or pharmacy" means a
  pharmacist or pharmacy that directly, or indirectly through one or
  more intermediaries, controls or is controlled by, or is under
  common control with, a pharmacy benefit manager.
               (2)  "Pharmacy [, "pharmacy] benefit manager" means a
  person, other than a pharmacy or pharmacist, who acts as an
  administrator in connection with pharmacy benefits.
         SECTION 2.  Subchapter D, Chapter 4151, Insurance Code, is
  amended by adding Sections 4151.155 and 4151.156 to read as
  follows:
         Sec. 4151.155.  PROHIBITION ON CERTAIN REFERRALS. (a) A
  pharmacy benefit manager may not steer or direct a patient to use an
  affiliated pharmacist or pharmacy through any oral or written
  communication, including:
               (1)  online messaging regarding the pharmacist or
  pharmacy; or
               (2)  patient- or prospective patient-specific
  advertising, marketing, or promotion of the pharmacist or pharmacy.
         (b)  This section does not prohibit a pharmacy benefit
  manager from including an affiliated pharmacist or pharmacy in the
  manager's patient communications, including in a patient- or
  prospective patient-specific communication, if the communication:
               (1)  is regarding in-network pharmacies and prices for
  a health benefit plan;
               (2)  is accurate; and
               (3)  includes in-network pharmacists or pharmacies
  that are not affiliated pharmacists or pharmacies.
         (c)  An affiliated pharmacist or pharmacy may not present a
  claim for payment to any individual or entity, including to a
  third-party payor, health benefit plan, or pharmacy benefit
  manager, for a health care service or supply provided to a patient
  who was improperly steered or directed to use the affiliated
  pharmacist or pharmacy in violation of Subsection (a).
         Sec. 4151.156.  PROHIBITION ON SHARING PATIENT INFORMATION
  FOR CERTAIN PURPOSES. (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 pharmacy benefit manager may not transfer to or
  receive from an affiliated pharmacist or pharmacy a record
  containing patient- or prescriber-identifiable prescription
  information for a commercial purpose.
         SECTION 3.  This Act takes effect September 1, 2021.