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A BILL TO BE ENTITLED
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AN ACT
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relating to use of a pharmacy benefit manager in which a health |
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benefit plan issuer has a financial interest. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1369, Insurance Code, is amended by |
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adding Subchapter R to read as follows: |
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SUBCHAPTER R. USE OF CERTAIN PHARMACY BENEFIT MANAGERS |
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Sec. 1369.801. DEFINITIONS. In this subchapter: |
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(1) "Financial interest" means an ownership or |
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investment interest through equity, debt, or other means, including |
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an interest in an entity that holds an ownership or investment |
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interest. |
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(2) "Pharmacy benefit manager" has the meaning |
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assigned by Section 4151.151. |
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Sec. 1369.802. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(8) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(9) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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Sec. 1369.803. PROHIBITION ON REQUIRING USE OF CERTAIN |
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PHARMACY BENEFIT MANAGERS. A health benefit plan issuer that has a |
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financial interest in a pharmacy benefit manager may not require an |
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enrollee to use the pharmacy benefit manager. |
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SECTION 2. Subchapter R, Chapter 1369, Insurance Code, as |
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added by this Act, applies only to a health benefit plan delivered, |
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issued for delivery, or renewed on or after January 1, 2026. |
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SECTION 3. This Act takes effect September 1, 2025. |