Texas 2021 - 87th Regular

Texas Senate Bill SB2195 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Kolkhorst, et al. S.B. No. 2195
	1	+	By: Kolkhorst, Lucio S.B. No. 2195
	2	+	(In the Senate - Filed April 11, 2021; April 12, 2021, read
	3	+	first time and referred to Committee on Health & Human Services;
	4	+	April 26, 2021, reported adversely, with favorable Committee
	5	+	Substitute by the following vote: Yeas 9, Nays 0; April 26, 2021,
	6	+	sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 2195 By: Seliger
2	9
3	10
4	11		A BILL TO BE ENTITLED
5	12		AN ACT
6	13		relating to the relationship between pharmacists or pharmacies and
7	14		pharmacy benefit managers or health benefit plan issuers.
8	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	16		SECTION 1. Subchapter D, Chapter 4151, Insurance Code, is
10	17		amended by adding Section 4151.155 to read as follows:
11	18		Sec. 4151.155. REDUCTION OF CERTAIN CLAIM PAYMENT AMOUNTS
12	19		PROHIBITED. (a) A pharmacy benefit manager may not directly or
13	20		indirectly reduce the amount of a claim payment to a pharmacist or
14	21		pharmacy after adjudication of the claim through the use of an
15	22		aggregated effective rate, a quality assurance program, other
16	23		direct or indirect remuneration fee, or otherwise, except in
17	24		accordance with an audit.
18	25		(b) Nothing in this section prohibits a pharmacy benefit
19	26		manager from increasing a claim payment amount after adjudication
20	27		of the claim.
21	28		(c) Notwithstanding any other law, this section applies to
22	29		the Medicaid managed care program operated under Chapter 533,
23	30		Government Code.
24	31		SECTION 2. Chapter 562, Occupations Code, is amended by
25	32		adding Subchapter E to read as follows:
26	33		SUBCHAPTER E. CONTRACTS WITH PHARMACISTS AND PHARMACIES
27	34		Sec. 562.201. DEFINITION. In this subchapter, "pharmacy
28	35		benefit manager" has the meaning assigned by Section 4151.151,
29	36		Insurance Code.
30	37		Sec. 562.202. APPLICABILITY OF SUBCHAPTER. (a) This
31	38		subchapter applies only to a health benefit plan that provides
32	39		benefits for medical or surgical expenses incurred as a result of a
33	40		health condition, accident, or sickness, including an individual,
34	41		group, blanket, or franchise insurance policy or insurance
35	42		agreement, a group hospital service contract, or an individual or
36	43		group evidence of coverage or similar coverage document that is
37	44		offered by:
38	45		(1) an insurance company;
39	46		(2) a group hospital service corporation operating
40	47		under Chapter 842, Insurance Code;
41	48		(3) a health maintenance organization operating under
42	49		Chapter 843, Insurance Code;
43	50		(4) an approved nonprofit health corporation that
44	51		holds a certificate of authority under Chapter 844, Insurance Code;
45	52		(5) a multiple employer welfare arrangement that holds
46	53		a certificate of authority under Chapter 846, Insurance Code;
47	54		(6) a stipulated premium company operating under
48	55		Chapter 884, Insurance Code;
49	56		(7) a fraternal benefit society operating under
50	57		Chapter 885, Insurance Code;
51	58		(8) a Lloyd's plan operating under Chapter 941,
52	59		Insurance Code; or
53	60		(9) an exchange operating under Chapter 942, Insurance
54	61		Code.
55	62		(b) Notwithstanding any other law, this subchapter applies
56	63		to:
57	64		(1) a small employer health benefit plan subject to
58	65		Chapter 1501, Insurance Code, including coverage provided through a
59	66		health group cooperative under Subchapter B of that chapter;
60	67		(2) a standard health benefit plan issued under
61	68		Chapter 1507, Insurance Code;
62	69		(3) health benefits provided by or through a church
63	70		benefits board under Subchapter I, Chapter 22, Business
64	71		Organizations Code;
65	72		(4) a regional or local health care program operated
66	73		under Section 75.104, Health and Safety Code; and
67	74		(5) a self-funded health benefit plan sponsored by a
68	75		professional employer organization under Chapter 91, Labor Code.
69	76		Sec. 562.203. PROFESSIONAL STANDARDS AND SCOPE OF PRACTICE
70	77		REQUIREMENTS. A health benefit plan issuer or pharmacy benefit
71	78		manager may not as a condition of a contract with a pharmacist or
72	79		pharmacy:
73	80		(1) require pharmacist or pharmacy accreditation
74	81		standards or recertification requirements inconsistent with, more
75	82		stringent than, or in addition to federal and state requirements;
76	83		or
77	84		(2) prohibit a licensed pharmacist or pharmacy from
78	85		dispensing any drug, including a specialty drug, that may be
79	86		dispensed under the pharmacist's or pharmacy's license unless
80	87		applicable state or federal law prohibits the pharmacist or
81	88		pharmacy from dispensing the drug.
82	89		Sec. 562.204. RESTRICTIONS ON MAIL ORDER PHARMACY SERVICES.
83	90		A pharmacy benefit manager may not require an enrollee to use a mail
84	91		order pharmacy.
85	92		Sec. 562.205. DELIVERY OF DRUGS. Except in a case in which
86	93		the health benefit plan issuer or pharmacy benefit manager makes a
87	94		credible allegation of fraud against the pharmacist or pharmacy and
88	95		provides reasonable notice of the allegation and the basis of the
89	96		allegation to the pharmacist or pharmacy, a health benefit plan
90	97		issuer or pharmacy benefit manager may not as a condition of a
91	98		contract with a pharmacist or pharmacy prohibit the pharmacist or
92	99		pharmacy from:
93	100		(1) mailing or delivering a drug to a patient on the
94	101		patient's request, to the extent permitted by law; or
95	102		(2) charging a shipping and handling fee to a patient
96	103		requesting a prescription be mailed or delivered if the pharmacist
97	104		or pharmacy discloses to the patient before the delivery:
98	105		(A) the fee that will be charged; and
99	106		(B) that the fee may not be reimbursable by the
100	107		health benefit plan issuer or pharmacy benefit manager.
101	108		Sec. 562.206. WAIVER PROHIBITED. The provisions of this
102	109		subchapter may not be waived, voided, or nullified by contract.
103		-	SECTION 3. The Health and Human Services Commission is
104		-	required to implement a provision of this Act only if the
105		-	legislature appropriates money to the commission specifically for
106		-	that purpose. If the legislature does not appropriate money
107		-	specifically for that purpose, the commission may, but is not
108		-	required to, implement a provision of this Act using other
109		-	appropriations that are available for that purpose.
110		-	SECTION 4. The change in law made by this Act applies only
	110	+	SECTION 3. The change in law made by this Act applies only
111	111		to a contract entered into or renewed on or after the effective date
112	112		of this Act. A contract entered into or renewed before the
113	113		effective date of this Act is governed by the law as it existed
114	114		immediately before the effective date of this Act, and that law is
115	115		continued in effect for that purpose.
116		-	SECTION 5. This Act takes effect September 1, 2021.
	116	+	SECTION 4. This Act takes effect September 1, 2021.
	117	+	* * * * *