Bill Text: TX SB812 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to prohibited practices for certain health benefit plan issuers and pharmacy benefit managers.
Spectrum: Slight Partisan Bill (Republican 3-1)
Status: (Introduced - Dead) 2021-03-22 - Co-author authorized [SB812 Detail]
Download: Texas-2021-SB812-Introduced.html
87R10443 TYPED | ||
By: Schwertner | S.B. No. 812 |
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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. |