2021S0161-1 03/05/21
By: Schwertner, Buckingham S.B. No. 1161
A BILL TO BE ENTITLED
AN ACT
relating to patient choice in the dispensing of
clinician-administered drugs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 1369, Insurance Code, is
amended by adding Section 1369.0042 to read as follows:
Sec. 1369.0042. PROHIBITION AGAINST LIMITING PATIENT
CHOICE WITH CLINICIAN-ADMINISTERED DRUGS. (a) In this section:
(1) "Administer" means to directly apply a drug to the
body of a patient by injection, inhalation, ingestion, or any other
means.
(2) "Clinician-administered drug" means an outpatient
prescription drug other than a vaccine that:
(A) cannot reasonably be self-administered by
the patient to whom the drug is prescribed or by an individual
assisting the patient with the self-administration; and
(B) is typically administered:
(i) by a physician or other health care
provider authorized under the laws of this state to administer the
drug, including when acting under a physician's delegation and
supervision; and
(ii) in a physician's office, hospital
outpatient infusion center, or other clinical setting.
(3) "Physician" means an individual licensed to
practice medicine in this state.
(4) "Health care provider" means an individual who is
licensed, certified, or otherwise authorized to provide health care
services in this state.
(b) An individual or group accident and health insurance
policy, contract, or agreement governed by the laws of this state
may not:
(1) require clinician-administered drugs to be
dispensed by a pharmacy selected by the health plan;
(2) if a clinician-administered drug is otherwise
covered, limit or exclude coverage for such drugs when not
dispensed by a pharmacy selected by the health plan;
(3) reimburse at a lesser amount
clinician-administered drugs dispensed by a pharmacy not selected
by the health plan; or
(4) require that an enrollee covered under such a
policy, contract, or agreement pay an additional fee, higher copay,
higher coinsurance, second copay, second coinsurance, or any other
form of price increase for clinician-administered drugs when not
dispensed by a pharmacy selected by the health plan.
(c) Nothing in this section may be construed as:
(1) authorizing a person to administer a drug when
otherwise prohibited under the laws of this state or federal law; or
(2) modifying drug administration requirements under
the laws of this state, including any requirements related to
delegation and supervision of drug administration.
SECTION 2. This Act takes effect September 1, 2021.