Texas 2025 - 89th Regular

Texas House Bill HB4422 Compare Versions

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

Old	New	Differences
1	1	89R14852 RDS-D
2	2	By: Rose H.B. No. 4422
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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 with
11	11	respect to certain entities participating in a federal drug
12	12	discount program.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Chapter 1369, Insurance Code, is amended by
15	15	adding Subchapter O to read as follows:
16	16	SUBCHAPTER O. PROHIBITION ON DISCRIMINATION WITH RESPECT TO
17	17	FEDERAL 340B DRUG DISCOUNT PROGRAM
18	18	Sec. 1369.701. DEFINITIONS. In this subchapter:
19	19	(1) "Covered entity" has the meaning assigned by 42
20	20	U.S.C. Section 256b(a)(4).
21	21	(2) "Non-covered entity" means an entity that is not a
22	22	covered entity.
23	23	(3) "Pharmacy benefit manager" has the meaning
24	24	assigned by Section 4151.151.
25	25	(4) "Third-party payor" means any person, other than a
26	26	pharmacy benefit manager, health benefit plan issuer, patient, or
27	27	individual paying for a patient's drugs on the patient's behalf,
28	28	that makes payment for drugs dispensed by a pharmacist or pharmacy
29	29	or administered by a health care professional.
30	30	Sec. 1369.702. APPLICABILITY OF SUBCHAPTER. (a) This
31	31	subchapter applies only to a health benefit plan that provides
32	32	benefits for medical or surgical expenses incurred as a result of a
33	33	health condition, accident, or sickness, including an individual,
34	34	group, blanket, or franchise insurance policy or insurance
35	35	agreement, a group hospital service contract, or an individual or
36	36	group evidence of coverage or similar coverage document that is
37	37	issued by:
38	38	(1) an insurance company;
39	39	(2) a group hospital service corporation operating
40	40	under Chapter 842;
41	41	(3) a health maintenance organization operating under
42	42	Chapter 843;
43	43	(4) an approved nonprofit health corporation that
44	44	holds a certificate of authority under Chapter 844;
45	45	(5) a multiple employer welfare arrangement that holds
46	46	a certificate of authority under Chapter 846;
47	47	(6) a stipulated premium company operating under
48	48	Chapter 884;
49	49	(7) a fraternal benefit society operating under
50	50	Chapter 885;
51	51	(8) a Lloyd's plan operating under Chapter 941; or
52	52	(9) an exchange operating under Chapter 942.
53	53	(b) Notwithstanding any other law, this subchapter applies
54	54	to:
55	55	(1) a small employer health benefit plan subject to
56	56	Chapter 1501, including coverage provided through a health group
57	57	cooperative under Subchapter B of that chapter;
58	58	(2) a standard health benefit plan issued under
59	59	Chapter 1507;
60	60	(3) a basic coverage plan under Chapter 1551;
61	61	(4) a basic plan under Chapter 1575;
62	62	(5) a primary care coverage plan under Chapter 1579;
63	63	(6) a plan providing basic coverage under Chapter
64	64	1601;
65	65	(7) nonprofit agricultural organization health
66	66	benefits offered by a nonprofit agricultural organization under
67	67	Chapter 1682;
68	68	(8) alternative health benefit coverage offered by a
69	69	subsidiary of the Texas Mutual Insurance Company under Subchapter
70	70	M, Chapter 2054;
71	71	(9) health benefits provided by or through a church
72	72	benefits board under Subchapter I, Chapter 22, Business
73	73	Organizations Code;
74	74	(10) group health coverage made available by a school
75	75	district in accordance with Section 22.004, Education Code;
76	76	(11) the state Medicaid program, including the
77	77	Medicaid managed care program operated under Chapter 540,
78	78	Government Code;
79	79	(12) the child health plan program under Chapter 62,
80	80	Health and Safety Code;
81	81	(13) a regional or local health care program operated
82	82	under Section 75.104, Health and Safety Code;
83	83	(14) a self-funded health benefit plan sponsored by a
84	84	professional employer organization under Chapter 91, Labor Code;
85	85	(15) county employee group health benefits provided
86	86	under Chapter 157, Local Government Code; and
87	87	(16) health and accident coverage provided by a risk
88	88	pool created under Chapter 172, Local Government Code.
89	89	Sec. 1369.703. PROHIBITION ON DISCRIMINATORY ACTIONS. A
90	90	health benefit plan issuer, pharmacy benefit manager, or
91	91	third-party payor may not:
92	92	(1) reimburse a covered entity or a pharmacist or
93	93	pharmacy that is under contract with the entity for a prescription
94	94	drug at a rate lower than the rate paid to a non-covered entity for
95	95	the same drug;
96	96	(2) impose a term on a covered entity that differs from
97	97	the terms applied to non-covered entities on the basis that the
98	98	entity is a covered entity, including:
99	99	(A) a fee, chargeback, or other adjustment that
100	100	is not placed on non-covered entities; or
101	101	(B) a restriction or requirement regarding
102	102	participation in a health benefit plan issuer, pharmacy benefit
103	103	manager, or third-party payor network, including a requirement that
104	104	a covered entity enter into a contract with a specific pharmacy or
105	105	pharmacist; or
106	106	(3) create a restriction applicable to or impose an
107	107	additional charge on a patient who chooses to receive a
108	108	prescription drug from a covered entity.
109	109	SECTION 2. Subchapter O, Chapter 1369, Insurance Code, as
110	110	added by this Act, applies only to a health benefit plan delivered,
111	111	issued for delivery, or renewed on or after January 1, 2026.
112	112	SECTION 3. It is the intent of the legislature that every
113	113	provision, section, subsection, sentence, clause, phrase, or word
114	114	in this Act, and every application of the provisions in this Act to
115	115	every person, group of persons, or circumstances, is severable from
116	116	each other. If any application of any provision in this Act to any
117	117	person, group of persons, or circumstances is found by a court to be
118	118	invalid for any reason, the remaining applications of that
119	119	provision to all other persons and circumstances shall be severed
120	120	and may not be affected.
121	121	SECTION 4. This Act takes effect September 1, 2025.