| 1 | 1 | | 87R6580 JES-F |
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| 2 | 2 | | By: Schwertner S.B. No. 727 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to certain prohibited practices by pharmacy benefit |
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| 8 | 8 | | managers. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 4151.151, Insurance Code, is amended to |
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| 11 | 11 | | read as follows: |
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| 12 | 12 | | Sec. 4151.151. DEFINITIONS [DEFINITION]. In this |
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| 13 | 13 | | subchapter: |
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| 14 | 14 | | (1) "Affiliated pharmacist or pharmacy" means a |
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| 15 | 15 | | pharmacist or pharmacy that directly, or indirectly through one or |
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| 16 | 16 | | more intermediaries, controls or is controlled by, or is under |
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| 17 | 17 | | common control with, a pharmacy benefit manager. |
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| 18 | 18 | | (2) "Pharmacy [, "pharmacy] benefit manager" means a |
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| 19 | 19 | | person, other than a pharmacy or pharmacist, who acts as an |
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| 20 | 20 | | administrator in connection with pharmacy benefits. |
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| 21 | 21 | | SECTION 2. Subchapter D, Chapter 4151, Insurance Code, is |
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| 22 | 22 | | amended by adding Sections 4151.155 and 4151.156 to read as |
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| 23 | 23 | | follows: |
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| 24 | 24 | | Sec. 4151.155. PROHIBITION ON CERTAIN REFERRALS. (a) A |
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| 25 | 25 | | pharmacy benefit manager may not steer or direct a patient to use an |
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| 26 | 26 | | affiliated pharmacist or pharmacy through any oral or written |
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| 27 | 27 | | communication, including: |
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| 28 | 28 | | (1) online messaging regarding the pharmacist or |
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| 29 | 29 | | pharmacy; or |
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| 30 | 30 | | (2) patient- or prospective patient-specific |
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| 31 | 31 | | advertising, marketing, or promotion of the pharmacist or pharmacy. |
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| 32 | 32 | | (b) This section does not prohibit a pharmacy benefit |
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| 33 | 33 | | manager from including an affiliated pharmacist or pharmacy in the |
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| 34 | 34 | | manager's patient communications, including in a patient- or |
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| 35 | 35 | | prospective patient-specific communication, if the communication: |
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| 36 | 36 | | (1) is regarding in-network pharmacies and prices for |
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| 37 | 37 | | a health benefit plan; |
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| 38 | 38 | | (2) is accurate; and |
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| 39 | 39 | | (3) includes in-network pharmacists or pharmacies |
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| 40 | 40 | | that are not affiliated pharmacists or pharmacies. |
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| 41 | 41 | | (c) An affiliated pharmacist or pharmacy may not present a |
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| 42 | 42 | | claim for payment to any individual or entity, including to a |
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| 43 | 43 | | third-party payor, health benefit plan, or pharmacy benefit |
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| 44 | 44 | | manager, for a health care service or supply provided to a patient |
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| 45 | 45 | | who was improperly steered or directed to use the affiliated |
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| 46 | 46 | | pharmacist or pharmacy in violation of Subsection (a). |
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| 47 | 47 | | Sec. 4151.156. PROHIBITION ON SHARING PATIENT INFORMATION |
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| 48 | 48 | | FOR CERTAIN PURPOSES. (a) In this section, "commercial purpose" |
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| 49 | 49 | | does not include pharmacy reimbursement, formulary compliance, |
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| 50 | 50 | | pharmaceutical care, utilization review by a health care provider, |
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| 51 | 51 | | or a public health activity authorized by law. |
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| 52 | 52 | | (b) A pharmacy benefit manager may not transfer to or |
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| 53 | 53 | | receive from an affiliated pharmacist or pharmacy a record |
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| 54 | 54 | | containing patient- or prescriber-identifiable prescription |
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| 55 | 55 | | information for a commercial purpose. |
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| 56 | 56 | | SECTION 3. This Act takes effect September 1, 2021. |
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