Texas 2025 - 89th Regular

Texas House Bill HB3265 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R12912 RDS-D
2	2	By: Darby H.B. No. 3265
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to discriminatory practices by a health benefit plan
10	10	issuer, pharmacy benefit manager, and third-party payor and certain
11	11	prescription drug manufacturers, distributors, and related persons
12	12	with respect to certain entities participating in a federal drug
13	13	discount program; providing a civil penalty.
14	14	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
15	15	SECTION 1. Subchapter N, Chapter 431, Health and Safety
16	16	Code, is amended by adding Section 431.416 to read as follows:
17	17	Sec. 431.416. DISCRIMINATION WITH RESPECT TO FEDERAL 340B
18	18	DRUG DISCOUNT PROGRAM PROHIBITED. (a) In this section:
19	19	(1) "340B drug" and "covered entity" have the meanings
20	20	assigned by Section 1369.701, Insurance Code.
21	21	(2) "Package" has the meaning assigned by 21 U.S.C.
22	22	Section 360eee(11)(A).
23	23	(3) "Pharmacist" and "pharmacy" have the meanings
24	24	assigned by Section 551.003, Occupations Code.
25	25	(b) Except as provided by Subsection (c), a manufacturer,
26	26	repackager, logistics provider, third-party logistics provider,
27	27	wholesale distributor, or agent of a prescription drug may not,
28	28	either directly or indirectly:
29	29	(1) discriminate against a covered entity, a
30	30	pharmacist or pharmacy that is under contract with the covered
31	31	entity, or another entity that is authorized under the contract to
32	32	receive the drug on behalf of the covered entity;
33	33	(2) deny, restrict, prohibit, or otherwise limit the
34	34	acquisition of a 340B drug by, or delivery of the drug to, a covered
35	35	entity, a pharmacist or pharmacy that is under contract with the
36	36	covered entity, or another entity that is authorized under the
37	37	contract to receive the drug on behalf of the covered entity; or
38	38	(3) require a covered entity, a pharmacist or pharmacy
39	39	that is under contract with the covered entity, or another entity
40	40	that is authorized under the contract to receive a 340B drug on
41	41	behalf of the covered entity to submit any claim or utilization data
42	42	as a condition for the acquisition of a 340B drug by, or delivery of
43	43	a 340B drug to, the covered entity, pharmacist or pharmacy under
44	44	contract with the covered entity, or other entity authorized to
45	45	receive the drug, as applicable.
46	46	(c) This section does not apply to:
47	47	(1) the receipt of a 340B drug that is prohibited by
48	48	the United States Food and Drug Administration; or
49	49	(2) the submission of a claim or utilization data that
50	50	is required by the United States Department of Health and Human
51	51	Services.
52	52	(d) A person who has reasonable cause to believe another
53	53	person has violated this section may submit a complaint to the
54	54	department. The department may investigate the complaint. If the
55	55	department finds that the person subject to the complaint committed
56	56	a violation of this section, the department:
57	57	(1) shall refer the complaint to the attorney general;
58	58	and
59	59	(2) may, in accordance with Section 431.414, suspend
60	60	or revoke a license issued under this subchapter and held by the
61	61	person subject to the complaint.
62	62	(e) A person who violates this section commits a false,
63	63	misleading, or deceptive act or practice under Section 17.46,
64	64	Business & Commerce Code, except that a civil penalty may be
65	65	assessed in an amount not greater than $50,000 for each violation. A
66	66	person commits a separate violation for each package of 340B drugs
67	67	that is the subject of a violation of this section.
68	68	(f) The executive commissioner shall adopt rules necessary
69	69	to implement this section.
70	70	(g) This section does not create a private cause of action
71	71	against a person who violates this section.
72	72	(h) Nothing in this section may be construed or applied to
73	73	be:
74	74	(1) less restrictive than any federal law as to any
75	75	person regulated by this section; or
76	76	(2) in conflict with:
77	77	(A) federal law or a related regulation; or
78	78	(B) any law of this state that is compatible with
79	79	applicable federal law.
80	80	SECTION 2. Chapter 1369, Insurance Code, is amended by
81	81	adding Subchapter O to read as follows:
82	82	SUBCHAPTER O. PROHIBITION ON DISCRIMINATION WITH RESPECT TO
83	83	FEDERAL 340B DRUG DISCOUNT PROGRAM
84	84	Sec. 1369.701. DEFINITIONS. In this subchapter:
85	85	(1) "340B drug" means a covered outpatient drug within
86	86	the meaning of 42 U.S.C. Section 256b that has been subject to any
87	87	offer for reduced prices by a manufacturer under the 340B program
88	88	and is purchased, or is intended to be purchased, by a covered
89	89	entity.
90	90	(2) "340B program" means the federal drug discount
91	91	program established by Section 340B, Public Health Service Act (42
92	92	U.S.C. Section 256b).
93	93	(3) "Covered entity" has the meaning assigned by 42
94	94	U.S.C. Section 256b(a)(4).
95	95	(4) "Manufacturer" has the meaning assigned by Section
96	96	431.401, Health and Safety Code.
97	97	(5) "Non-covered entity" means an entity that is not a
98	98	covered entity.
99	99	(6) "Pharmacy benefit manager" has the meaning
100	100	assigned by Section 4151.151.
101	101	(7) "Third-party payor" means any person, other than a
102	102	pharmacy benefit manager, health benefit plan issuer, patient, or
103	103	individual paying for a patient's drugs on the patient's behalf,
104	104	that makes payment for drugs dispensed by a pharmacist or pharmacy
105	105	or administered by a health care professional.
106	106	Sec. 1369.702. APPLICABILITY OF SUBCHAPTER. (a) This
107	107	subchapter applies only to a health benefit plan that provides
108	108	benefits for medical or surgical expenses incurred as a result of a
109	109	health condition, accident, or sickness, including an individual,
110	110	group, blanket, or franchise insurance policy or insurance
111	111	agreement, a group hospital service contract, or an individual or
112	112	group evidence of coverage or similar coverage document that is
113	113	issued by:
114	114	(1) an insurance company;
115	115	(2) a group hospital service corporation operating
116	116	under Chapter 842;
117	117	(3) a health maintenance organization operating under
118	118	Chapter 843;
119	119	(4) an approved nonprofit health corporation that
120	120	holds a certificate of authority under Chapter 844;
121	121	(5) a multiple employer welfare arrangement that holds
122	122	a certificate of authority under Chapter 846;
123	123	(6) a stipulated premium company operating under
124	124	Chapter 884;
125	125	(7) a fraternal benefit society operating under
126	126	Chapter 885;
127	127	(8) a Lloyd's plan operating under Chapter 941; or
128	128	(9) an exchange operating under Chapter 942.
129	129	(b) Notwithstanding any other law, this subchapter applies
130	130	to:
131	131	(1) a small employer health benefit plan subject to
132	132	Chapter 1501, including coverage provided through a health group
133	133	cooperative under Subchapter B of that chapter;
134	134	(2) a standard health benefit plan issued under
135	135	Chapter 1507;
136	136	(3) a basic coverage plan under Chapter 1551;
137	137	(4) a basic plan under Chapter 1575;
138	138	(5) a primary care coverage plan under Chapter 1579;
139	139	(6) a plan providing basic coverage under Chapter
140	140	1601;
141	141	(7) nonprofit agricultural organization health
142	142	benefits offered by a nonprofit agricultural organization under
143	143	Chapter 1682;
144	144	(8) alternative health benefit coverage offered by a
145	145	subsidiary of the Texas Mutual Insurance Company under Subchapter
146	146	M, Chapter 2054;
147	147	(9) health benefits provided by or through a church
148	148	benefits board under Subchapter I, Chapter 22, Business
149	149	Organizations Code;
150	150	(10) group health coverage made available by a school
151	151	district in accordance with Section 22.004, Education Code;
152	152	(11) the state Medicaid program, including the
153	153	Medicaid managed care program operated under Chapter 540,
154	154	Government Code;
155	155	(12) the child health plan program under Chapter 62,
156	156	Health and Safety Code;
157	157	(13) a regional or local health care program operated
158	158	under Section 75.104, Health and Safety Code;
159	159	(14) a self-funded health benefit plan sponsored by a
160	160	professional employer organization under Chapter 91, Labor Code;
161	161	(15) county employee group health benefits provided
162	162	under Chapter 157, Local Government Code; and
163	163	(16) health and accident coverage provided by a risk
164	164	pool created under Chapter 172, Local Government Code.
165	165	Sec. 1369.703. PROHIBITION ON DISCRIMINATORY ACTIONS. A
166	166	health benefit plan issuer, pharmacy benefit manager, or
167	167	third-party payor may not:
168	168	(1) reimburse a covered entity or a pharmacist or
169	169	pharmacy that is under contract with the entity for a prescription
170	170	drug at a rate lower than the rate paid to a non-covered entity for
171	171	the same drug;
172	172	(2) require a covered entity or a pharmacy or
173	173	pharmacist under contract with the entity to include with a claim
174	174	for a prescription drug dispensed by the entity an identification,
175	175	billing modifier, attestation, or other indication that the drug is
176	176	a 340B drug in order to be processed or resubmitted;
177	177	(3) impose a term on a covered entity that differs from
178	178	the terms applied to non-covered entities on the basis that the
179	179	entity is a covered entity, including:
180	180	(A) a fee, chargeback, or other adjustment that
181	181	is not placed on non-covered entities; or
182	182	(B) a restriction or requirement regarding
183	183	participation in a health benefit plan issuer, pharmacy benefit
184	184	manager, or third-party payor network, including a requirement that
185	185	a covered entity enter into a contract with a specific pharmacy or
186	186	pharmacist; or
187	187	(4) discriminate against, create a restriction
188	188	applicable to, or impose an additional charge on a patient who
189	189	chooses to receive a prescription drug from a covered entity.
190	190	SECTION 3. (a) Section 431.416, Health and Safety Code, as
191	191	added by this Act, applies only to a prescription drug manufactured
192	192	on or after the effective date of this Act.
193	193	(b) Subchapter O, Chapter 1369, Insurance Code, as added by
194	194	this Act, applies only to a health benefit plan delivered, issued
195	195	for delivery, or renewed on or after January 1, 2026.
196	196	SECTION 4. It is the intent of the legislature that every
197	197	provision, section, subsection, sentence, clause, phrase, or word
198	198	in this Act, and every application of the provisions in this Act to
199	199	every person, group of persons, or circumstances, is severable from
200	200	each other. If any application of any provision in this Act to any
201	201	person, group of persons, or circumstances is found by a court to be
202	202	invalid for any reason, the remaining applications of that
203	203	provision to all other persons and circumstances shall be severed
204	204	and may not be affected.
205	205	SECTION 5. This Act takes effect September 1, 2025.