H.B. No. 1919
AN ACT
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 Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. AFFILIATED PROVIDERS
Sec. 1369.551. DEFINITIONS. In this subchapter:
(1) "Affiliated provider" means a pharmacy or durable
medical equipment provider that directly, or indirectly through one
or more intermediaries, controls, is controlled by, or is under
common control with a health benefit plan issuer or pharmacy
benefit manager.
(2) "Health benefit plan" has the meaning assigned by
Section 1369.251.
(3) "Pharmacy benefit manager" has the meaning
assigned by Section 4151.151.
Sec. 1369.552. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
Notwithstanding the definition of "health benefit plan" provided by
Section 1369.551, this subchapter does not apply to an issuer or
provider of health benefits under or a pharmacy benefit manager
administering pharmacy benefits under:
(1) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(2) the child health plan program under Chapter 62,
Health and Safety Code;
(3) the TRICARE military health system;
(4) a basic coverage plan under Chapter 1551;
(5) a basic plan under Chapter 1575;
(6) a coverage plan under Chapter 1579;
(7) a plan providing basic coverage under Chapter
1601; or
(8) a workers' compensation insurance policy or other
form of providing medical benefits under Title 5, Labor Code.
Sec. 1369.553. 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 health care provider,
or a public health activity authorized by law.
(b) A health benefit plan issuer or pharmacy benefit manager
may not transfer to or receive from the issuer's or manager's
affiliated provider a record containing patient- or
prescriber-identifiable prescription information for a commercial
purpose.
Sec. 1369.554. PROHIBITION ON CERTAIN COMMUNICATIONS. (a)
A health benefit plan issuer or pharmacy benefit manager may not
steer or direct a patient to use the issuer's or manager's
affiliated provider through any oral or written communication,
including:
(1) online messaging regarding the provider; or
(2) patient- or prospective patient-specific
advertising, marketing, or promotion of the provider.
(b) This section does not prohibit a health benefit plan
issuer or pharmacy benefit manager from including the issuer's or
manager's affiliated provider in a patient or prospective patient
communication, if the communication:
(1) is regarding information about the cost or service
provided by pharmacies or durable medical equipment providers in
the network of a health benefit plan in which the patient or
prospective patient is enrolled; and
(2) includes accurate comparable information
regarding pharmacies or durable medical equipment providers in the
network that are not the issuer's or manager's affiliated
providers.
Sec. 1369.555. PROHIBITION ON CERTAIN REFERRALS AND
SOLICITATIONS. (a) A health benefit plan issuer or pharmacy
benefit manager may not require a patient to use the issuer's or
manager's affiliated provider 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 the issuer's or manager's affiliated
provider, including by providing for reduced cost-sharing if the
patient uses the affiliated provider.
(c) A health benefit plan issuer or pharmacy benefit manager
may not solicit a patient or prescriber to transfer a patient
prescription to the issuer's or manager's affiliated provider.
(d) A health benefit plan issuer or pharmacy benefit manager
may not require a pharmacy or durable medical equipment provider
that is not the issuer's or manager's affiliated provider to
transfer a patient's prescription to the issuer's or manager's
affiliated provider without the prior written consent of the
patient.
SECTION 2. Sections 1369.555(a) and (b), Insurance Code, as
added by this Act, apply only to a health benefit plan delivered,
issued for delivery, or renewed on or after the effective date of
this Act.
SECTION 3. This Act takes effect September 1, 2021.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1919 was passed by the House on April
29, 2021, by the following vote: Yeas 128, Nays 16, 2 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 1919 on May 28, 2021, by the following vote: Yeas 124, Nays 21,
1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1919 was passed by the Senate, with
amendments, on May 24, 2021, by the following vote: Yeas 30, Nays
0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor