Bill Text: TX SB727 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to certain prohibited practices by pharmacy benefit managers.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2021-03-11 - Referred to Business & Commerce [SB727 Detail]
Download: Texas-2021-SB727-Introduced.html
87R6580 JES-F | ||
By: Schwertner | S.B. No. 727 |
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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 [ |
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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 [ |
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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. |