Texas 2021 - 87th Regular

Texas House Bill HB1919 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 1919
	1	+	By: Harris, et al. H.B. No. 1919
	2	+	(Senate Sponsor - Schwertner, et al.)
	3	+	(In the Senate - Received from the House May 3, 2021;
	4	+	May 13, 2021, read first time and referred to Committee on Health &
	5	+	Human Services; May 21, 2021, reported adversely, with favorable
	6	+	Committee Substitute by the following vote: Yeas 8, Nays 0;
	7	+	May 21, 2021, sent to printer.)
	8	+	Click here to see the committee vote
	9	+	COMMITTEE SUBSTITUTE FOR H.B. No. 1919 By: Perry
2	10
3	11
	12	+	A BILL TO BE ENTITLED
4	13		AN ACT
5		-	relating to prohibited practices for certain health benefit plan
6		-	issuers and pharmacy benefit managers.
	14	+	relating to certain prohibited practices for certain health benefit
	15	+	plan issuers and certain required and prohibited practices for
	16	+	certain pharmacy benefit managers.
7	17		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	18		SECTION 1. Chapter 1369, Insurance Code, is amended by
9		-	adding ~~Subchapter~~ L to read as follows:
	19	+	adding Subchapters L and M to read as follows:
10	20		SUBCHAPTER L. AFFILIATED PROVIDERS
11	21		Sec. 1369.551. DEFINITIONS. In this subchapter:
12	22		(1) "Affiliated provider" means a pharmacy or durable
13	23		medical equipment provider that directly, or indirectly through one
14	24		or more intermediaries, controls, is controlled by, or is under
15	25		common control with a health benefit plan issuer or pharmacy
16	26		benefit manager.
17	27		(2) "Health benefit plan" has the meaning assigned by
18	28		Section 1369.251.
19	29		(3) "Pharmacy benefit manager" has the meaning
20	30		assigned by Section 4151.151.
21	31		Sec. 1369.552. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
22	32		Notwithstanding the definition of "health benefit plan" provided by
23	33		Section 1369.551, this subchapter does not apply to an issuer or
24	34		provider of health benefits under or a pharmacy benefit manager
25	35		administering pharmacy benefits under:
26	36		(1) the state Medicaid program, including the Medicaid
27	37		managed care program operated under Chapter 533, Government Code;
28	38		(2) the child health plan program under Chapter 62,
29	39		Health and Safety Code;
30	40		(3) the TRICARE military health system;
31	41		(4) a basic coverage plan under Chapter 1551;
32	42		(5) a basic plan under Chapter 1575;
33		-	(6) a coverage plan under Chapter 1579;
	43	+	(6) a primary care coverage plan under Chapter 1579;
34	44		(7) a plan providing basic coverage under Chapter
35	45		1601; or
36	46		(8) a workers' compensation insurance policy or other
37	47		form of providing medical benefits under Title 5, Labor Code.
38	48		Sec. 1369.553. TRANSFER OR ACCEPTANCE OF CERTAIN RECORDS
39	49		PROHIBITED. (a) In this section, "commercial purpose" does not
40	50		include pharmacy reimbursement, formulary compliance,
41	51		pharmaceutical care, utilization review by a health care provider,
42	52		or a public health activity authorized by law.
43	53		(b) A health benefit plan issuer or pharmacy benefit manager
44	54		may not transfer to or receive from the issuer's or manager's
45	55		affiliated provider a record containing patient- or
46	56		prescriber-identifiable prescription information for a commercial
47	57		purpose.
48	58		Sec. 1369.554. PROHIBITION ON CERTAIN COMMUNICATIONS. (a)
49	59		A health benefit plan issuer or pharmacy benefit manager may not
50	60		steer or direct a patient to use the issuer's or manager's
51	61		affiliated provider through any oral or written communication,
52	62		including:
53	63		(1) online messaging regarding the provider; or
54	64		(2) patient- or prospective patient-specific
55	65		advertising, marketing, or promotion of the provider.
56	66		(b) This section does not prohibit a health benefit plan
57	67		issuer or pharmacy benefit manager from including the issuer's or
58	68		manager's affiliated provider in a patient or prospective patient
59	69		communication, if the communication:
60	70		(1) is regarding information about the cost or service
61	71		provided by pharmacies or durable medical equipment providers in
62	72		the network of a health benefit plan in which the patient or
63	73		prospective patient is enrolled; and
64	74		(2) includes accurate comparable information
65	75		regarding pharmacies or durable medical equipment providers in the
66	76		network that are not the issuer's or manager's affiliated
67	77		providers.
68	78		Sec. 1369.555. PROHIBITION ON CERTAIN REFERRALS AND
69	79		SOLICITATIONS. (a) A health benefit plan issuer or pharmacy
70	80		benefit manager may not require a patient to use the issuer's or
71	81		manager's affiliated provider in order for the patient to receive
72	82		the maximum benefit for the service under the patient's health
73	83		benefit plan.
74	84		(b) A health benefit plan issuer or pharmacy benefit manager
75	85		may not offer or implement a health benefit plan that requires or
76	86		induces a patient to use the issuer's or manager's affiliated
77	87		provider, including by providing for reduced cost-sharing if the
78	88		patient uses the affiliated provider.
79	89		(c) A health benefit plan issuer or pharmacy benefit manager
80	90		may not solicit a patient or prescriber to transfer a patient
81	91		prescription to the issuer's or manager's affiliated provider.
82	92		(d) A health benefit plan issuer or pharmacy benefit manager
83	93		may not require a pharmacy or durable medical equipment provider
84	94		that is not the issuer's or manager's affiliated provider to
85	95		transfer a patient's prescription to the issuer's or manager's
86	96		affiliated provider without the prior written consent of the
87	97		patient.
	98	+	SUBCHAPTER M. CLINICIAN-ADMINISTERED DRUGS
	99	+	Sec. 1369.601. DEFINITIONS. In this subchapter:
	100	+	(1) "Affiliated provider" means a pharmacy or durable
	101	+	medical equipment provider that directly, or indirectly through one
	102	+	or more intermediaries, controls, is controlled by, or is under
	103	+	common control with a health benefit plan issuer or pharmacy
	104	+	benefit manager.
	105	+	(2) "Clinician-administered drug" means an outpatient
	106	+	prescription drug other than a vaccine that:
	107	+	(A) cannot reasonably be:
	108	+	(i) self-administered by the patient to
	109	+	whom the drug is prescribed; or
	110	+	(ii) administered by an individual
	111	+	assisting the patient with the self-administration; and
	112	+	(B) is typically administered:
	113	+	(i) by a physician or other health care
	114	+	provider authorized under the laws of this state to administer the
	115	+	drug, including when acting under a physician's delegation and
	116	+	supervision; and
	117	+	(ii) in a physician's office, hospital
	118	+	outpatient infusion center, or other clinical setting.
	119	+	(3) "Health care provider" means an individual who is
	120	+	licensed, certified, or otherwise authorized to provide health care
	121	+	services in this state.
	122	+	(4) "Pharmacy benefit manager" has the meaning
	123	+	assigned by Section 4151.151.
	124	+	(5) "Physician" means an individual licensed to
	125	+	practice medicine in this state.
	126	+	Sec. 1369.602. APPLICABILITY OF SUBCHAPTER. (a) This
	127	+	subchapter applies only to a health benefit plan that provides
	128	+	benefits for medical or surgical expenses incurred as a result of a
	129	+	health condition, accident, or sickness, including an individual,
	130	+	group, blanket, or franchise insurance policy or insurance
	131	+	agreement, a group hospital service contract, or an individual or
	132	+	group evidence of coverage or similar coverage document that is
	133	+	offered by:
	134	+	(1) an insurance company;
	135	+	(2) a group hospital service corporation operating
	136	+	under Chapter 842;
	137	+	(3) a health maintenance organization operating under
	138	+	Chapter 843;
	139	+	(4) an approved nonprofit health corporation that
	140	+	holds a certificate of authority under Chapter 844;
	141	+	(5) a multiple employer welfare arrangement that holds
	142	+	a certificate of authority under Chapter 846;
	143	+	(6) a stipulated premium company operating under
	144	+	Chapter 884;
	145	+	(7) a fraternal benefit society operating under
	146	+	Chapter 885;
	147	+	(8) a Lloyd's plan operating under Chapter 941; or
	148	+	(9) an exchange operating under Chapter 942.
	149	+	(b) Notwithstanding any other law, this subchapter applies
	150	+	to:
	151	+	(1) a small employer health benefit plan subject to
	152	+	Chapter 1501, including coverage provided through a health group
	153	+	cooperative under Subchapter B of that chapter;
	154	+	(2) a standard health benefit plan issued under
	155	+	Chapter 1507;
	156	+	(3) health benefits provided by or through a church
	157	+	benefits board under Subchapter I, Chapter 22, Business
	158	+	Organizations Code;
	159	+	(4) a regional or local health care program operating
	160	+	under Section 75.104, Health and Safety Code; and
	161	+	(5) a self-funded health benefit plan sponsored by a
	162	+	professional employer organization under Chapter 91, Labor Code.
	163	+	(c) This subchapter does not apply to an issuer or provider
	164	+	of health benefits under or a pharmacy benefit manager
	165	+	administering pharmacy benefits under a workers' compensation
	166	+	insurance policy or other form of providing medical benefits under
	167	+	Title 5, Labor Code.
	168	+	Sec. 1369.603. CERTAIN LIMITATIONS RELATED TO
	169	+	CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit plan
	170	+	issuer or pharmacy benefit manager may not, for a patient with a
	171	+	cancer or cancer-related diagnosis:
	172	+	(1) require a clinician-administered drug to be
	173	+	dispensed by a pharmacy, including by an affiliated provider; or
	174	+	(2) require that a clinician-administered drug or the
	175	+	administration of a clinician-administered drug be covered as a
	176	+	pharmacy benefit rather than a medical benefit.
	177	+	(b) Nothing in this section may be construed to:
	178	+	(1) authorize a person to administer a drug when
	179	+	otherwise prohibited under the laws of this state or federal law; or
	180	+	(2) modify drug administration requirements under the
	181	+	laws of this state, including any requirements related to
	182	+	delegation and supervision of drug administration.
88	183		SECTION 2. Sections 1369.555(a) and (b), Insurance Code, as
89	184		added by this Act, apply only to a health benefit plan delivered,
90	185		issued for delivery, or renewed on or after the effective date of
91	186		this Act.
92		-	SECTION 3. This Act takes effect September 1, 2021.
93		-	______________________________ ______________________________
94		-	President of the Senate Speaker of the House
95		-	I certify that H.B. No. 1919 was passed by the House on April
96		-	29, 2021, by the following vote: Yeas 128, Nays 16, 2 present, not
97		-	voting; and that the House concurred in Senate amendments to H.B.
98		-	No. 1919 on May 28, 2021, by the following vote: Yeas 124, Nays 21,
99		-	1 present, not voting.
100		-	______________________________
101		-	Chief Clerk of the House
102		-	I certify that H.B. No. 1919 was passed by the Senate, with
103		-	amendments, on May 24, 2021, by the following vote: Yeas 30, Nays
104		-	0.
105		-	______________________________
106		-	Secretary of the Senate
107		-	APPROVED: __________________
108		-	Date
109		-	__________________
110		-	Governor
	187	+	SECTION 3. Subchapter M, Chapter 1369, Insurance Code, as
	188	+	added by this Act, applies only to a health benefit plan that is
	189	+	delivered, issued for delivery, or renewed on or after January 1,
	190	+	2022.
	191	+	SECTION 4. This Act takes effect September 1, 2021.
	192	+	* * * * *