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AN ACT
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relating to regulation of certain conduct by discount health care |
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program operators, or concerning discount health care programs, |
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that relates to prescription drugs or prescription drug benefits; |
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authorizing administrative and civil penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 562, Insurance Code, is |
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amended by adding Sections 562.055 and 562.056 to read as follows: |
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Sec. 562.055. NETWORK PARTICIPATION REQUIREMENTS. (a) It |
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is an unfair method of competition or an unfair or deceptive act or |
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practice in the business of discount health care programs for a |
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discount health care program operator or an affiliate or agent of a |
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discount health care program operator to require a pharmacy or |
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pharmacist to: |
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(1) participate in a specified provider network as a |
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condition of processing a claim for prescription drugs under the |
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discount health care program; or |
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(2) participate in, or process claims under, a |
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discount health care program as a condition of participation in a |
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provider network. |
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(b) A discount health care program operator is not legally |
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liable for any act or omission of an agent of the operator in |
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violation of Subsection (a). |
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Sec. 562.056. CERTAIN METHODS OF PROMOTIONS. (a) It is an |
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unfair method of competition or an unfair or deceptive act or |
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practice in the business of discount health care programs for a |
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discount health care program operator to pay any consideration to a |
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health care services provider or employee of a health care services |
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provider: |
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(1) to encourage an individual to claim a discount for |
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prescription drugs under a discount health care program; or |
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(2) to include discount health care program |
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information on a prescription for a drug or in materials |
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accompanying the prescription. |
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(b) It is an unfair method of competition or an unfair or |
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deceptive act or practice in the business of discount health care |
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programs for a discount health care program operator to provide a |
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person with written prescription forms that could reasonably |
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mislead an individual to believe that the discount health care |
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program is health insurance or provides coverage similar to health |
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insurance. |
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SECTION 2. Subchapter D, Chapter 4151, Insurance Code, is |
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amended by adding Section 4151.154 to read as follows: |
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Sec. 4151.154. DISCOUNT HEALTH CARE PROGRAMS. A pharmacy |
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benefit manager may not require a pharmacist or pharmacy to: |
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(1) accept or process a claim for prescription drugs |
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under a discount health care program as defined by Section 7001.001 |
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unless the pharmacist or pharmacy agrees in writing to accept or |
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process the claim; |
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(2) participate in a specified provider network as a |
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condition of processing a claim for prescription drugs under a |
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discount health care program; or |
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(3) participate in, or process claims under, a |
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discount health care program as a condition of participation in a |
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provider network. |
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SECTION 3. (a) Except as provided by Subsection (b) of this |
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section, the changes in law made by this Act apply only to conduct |
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that occurs on or after the effective date of this Act. Conduct that |
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occurs before the effective date of this Act is governed by the law |
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as it existed when the conduct occurred, and the former law is |
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continued in effect for that purpose. |
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(b) The changes in law made by this Act apply only to a claim |
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filed under a discount health care program on or after the effective |
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date of this Act. A claim filed before the effective date of this |
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Act is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2015. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 3028 was passed by the House on May |
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13, 2015, by the following vote: Yeas 144, Nays 0, 2 present, not |
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voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 3028 was passed by the Senate on May |
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22, 2015, by the following vote: Yeas 30, Nays 1. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: _____________________ |
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Date |
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_____________________ |
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Governor |