| 1 | 1 | | 89R12314 SCF-F |
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| 2 | 2 | | By: Harris H.B. No. 2750 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to use of a pharmacy benefit manager in which a health |
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| 10 | 10 | | benefit plan issuer has a financial interest. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Chapter 1369, Insurance Code, is amended by |
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| 13 | 13 | | adding Subchapter R to read as follows: |
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| 14 | 14 | | SUBCHAPTER R. USE OF CERTAIN PHARMACY BENEFIT MANAGERS |
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| 15 | 15 | | Sec. 1369.801. DEFINITIONS. In this subchapter: |
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| 16 | 16 | | (1) "Financial interest" means an ownership or |
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| 17 | 17 | | investment interest through equity, debt, or other means, including |
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| 18 | 18 | | an interest in an entity that holds an ownership or investment |
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| 19 | 19 | | interest. |
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| 20 | 20 | | (2) "Pharmacy benefit manager" has the meaning |
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| 21 | 21 | | assigned by Section 4151.151. |
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| 22 | 22 | | Sec. 1369.802. APPLICABILITY OF SUBCHAPTER. (a) This |
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| 23 | 23 | | subchapter applies only to a health benefit plan that provides |
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| 24 | 24 | | benefits for medical or surgical expenses incurred as a result of a |
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| 25 | 25 | | health condition, accident, or sickness, including an individual, |
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| 26 | 26 | | group, blanket, or franchise insurance policy or insurance |
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| 27 | 27 | | agreement, a group hospital service contract, or an individual or |
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| 28 | 28 | | group evidence of coverage or similar coverage document that is |
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| 29 | 29 | | issued by: |
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| 30 | 30 | | (1) an insurance company; |
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| 31 | 31 | | (2) a group hospital service corporation operating |
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| 32 | 32 | | under Chapter 842; |
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| 33 | 33 | | (3) a health maintenance organization operating under |
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| 34 | 34 | | Chapter 843; |
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| 35 | 35 | | (4) an approved nonprofit health corporation that |
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| 36 | 36 | | holds a certificate of authority under Chapter 844; |
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| 37 | 37 | | (5) a multiple employer welfare arrangement that holds |
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| 38 | 38 | | a certificate of authority under Chapter 846; |
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| 39 | 39 | | (6) a stipulated premium company operating under |
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| 40 | 40 | | Chapter 884; |
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| 41 | 41 | | (7) a fraternal benefit society operating under |
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| 42 | 42 | | Chapter 885; |
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| 43 | 43 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 44 | 44 | | (9) an exchange operating under Chapter 942. |
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| 45 | 45 | | (b) Notwithstanding any other law, this subchapter applies |
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| 46 | 46 | | to: |
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| 47 | 47 | | (1) a small employer health benefit plan subject to |
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| 48 | 48 | | Chapter 1501, including coverage provided through a health group |
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| 49 | 49 | | cooperative under Subchapter B of that chapter; |
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| 50 | 50 | | (2) a standard health benefit plan issued under |
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| 51 | 51 | | Chapter 1507; |
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| 52 | 52 | | (3) a basic coverage plan under Chapter 1551; |
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| 53 | 53 | | (4) a basic plan under Chapter 1575; |
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| 54 | 54 | | (5) a primary care coverage plan under Chapter 1579; |
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| 55 | 55 | | (6) a plan providing basic coverage under Chapter |
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| 56 | 56 | | 1601; |
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| 57 | 57 | | (7) group health coverage made available by a school |
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| 58 | 58 | | district in accordance with Section 22.004, Education Code; |
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| 59 | 59 | | (8) a regional or local health care program operated |
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| 60 | 60 | | under Section 75.104, Health and Safety Code; and |
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| 61 | 61 | | (9) a self-funded health benefit plan sponsored by a |
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| 62 | 62 | | professional employer organization under Chapter 91, Labor Code. |
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| 63 | 63 | | Sec. 1369.803. PROHIBITION ON REQUIRING USE OF CERTAIN |
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| 64 | 64 | | PHARMACY BENEFIT MANAGERS. A health benefit plan issuer that has a |
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| 65 | 65 | | financial interest in a pharmacy benefit manager may not require an |
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| 66 | 66 | | enrollee to use the pharmacy benefit manager. |
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| 67 | 67 | | SECTION 2. Subchapter R, Chapter 1369, Insurance Code, as |
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| 68 | 68 | | added by this Act, applies only to a health benefit plan delivered, |
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| 69 | 69 | | issued for delivery, or renewed on or after January 1, 2026. |
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| 70 | 70 | | SECTION 3. This Act takes effect September 1, 2025. |
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