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A BILL TO BE ENTITLED
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AN ACT
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relating to certain prohibited practices by pharmacy benefit |
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managers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 4151.151, Insurance Code, is amended to |
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read as follows: |
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Sec. 4151.151. DEFINITIONS [DEFINITION]. In this |
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subchapter: |
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(1) "Affiliated pharmacist or pharmacy" means a |
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pharmacist or pharmacy that directly, or indirectly through one or |
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more intermediaries, controls or is controlled by, or is under |
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common control with, a pharmacy benefit manager. |
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(2) "Pharmacy [, "pharmacy] benefit manager" means a |
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person, other than a pharmacy or pharmacist, who acts as an |
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administrator in connection with pharmacy benefits. |
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SECTION 2. Subchapter D, Chapter 4151, Insurance Code, is |
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amended by adding Sections 4151.155 and 4151.156 to read as |
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follows: |
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Sec. 4151.155. PROHIBITION ON CERTAIN REFERRALS. (a) A |
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pharmacy benefit manager may not steer or direct a patient to use an |
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affiliated pharmacist or pharmacy through any oral or written |
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communication, including: |
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(1) online messaging regarding the pharmacist or |
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pharmacy; or |
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(2) patient- or prospective patient-specific |
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advertising, marketing, or promotion of the pharmacist or pharmacy. |
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(b) This section does not prohibit a pharmacy benefit |
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manager from including an affiliated pharmacist or pharmacy in the |
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manager's patient communications, including in a patient- or |
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prospective patient-specific communication, if the communication: |
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(1) is regarding in-network pharmacies and prices for |
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a health benefit plan; |
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(2) is accurate; and |
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(3) includes in-network pharmacists or pharmacies |
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that are not affiliated pharmacists or pharmacies. |
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(c) An affiliated pharmacist or pharmacy may not present a |
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claim for payment to any individual or entity, including to a |
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third-party payor, health benefit plan, or pharmacy benefit |
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manager, for a health care service or supply provided to a patient |
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who was improperly steered or directed to use the affiliated |
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pharmacist or pharmacy in violation of Subsection (a). |
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Sec. 4151.156. PROHIBITION ON SHARING PATIENT INFORMATION |
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FOR CERTAIN PURPOSES. (a) In this section, "commercial purpose" |
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does not include pharmacy reimbursement, formulary compliance, |
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pharmaceutical care, utilization review by a health care provider, |
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or a public health activity authorized by law. |
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(b) A pharmacy benefit manager may not transfer to or |
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receive from an affiliated pharmacist or pharmacy a record |
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containing patient- or prescriber-identifiable prescription |
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information for a commercial purpose. |
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SECTION 3. This Act takes effect September 1, 2021. |