H.B. No. 1919

	AN ACT
	relating to prohibited practices for certain health benefit plan
	issuers and pharmacy benefit managers.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1369, Insurance Code, is amended by
	adding Subchapter L to read as follows:
	SUBCHAPTER L. AFFILIATED PROVIDERS
	Sec. 1369.551.  DEFINITIONS. In this subchapter:
	(1)  "Affiliated provider" means a pharmacy or durable
	medical equipment provider that directly, or indirectly through one
	or more intermediaries, controls, is controlled by, or is under
	common control with a health benefit plan issuer or pharmacy
	benefit manager.
	(2)  "Health benefit plan" has the meaning assigned by
	Section 1369.251.
	(3)  "Pharmacy benefit manager" has the meaning
	assigned by Section 4151.151.
	Sec. 1369.552.  EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
	Notwithstanding the definition of "health benefit plan" provided by
	Section 1369.551, this subchapter does not apply to an issuer or
	provider of health benefits under or a pharmacy benefit manager
	administering pharmacy benefits under:
	(1)  the state Medicaid program, including the Medicaid
	managed care program operated under Chapter 533, Government Code;
	(2)  the child health plan program under Chapter 62,
	Health and Safety Code;
	(3)  the TRICARE military health system;
	(4)  a basic coverage plan under Chapter 1551;
	(5)  a basic plan under Chapter 1575;
	(6)  a coverage plan under Chapter 1579;
	(7)  a plan providing basic coverage under Chapter
	1601; or
	(8)  a workers' compensation insurance policy or other
	form of providing medical benefits under Title 5, Labor Code.
	Sec. 1369.553.  TRANSFER OR ACCEPTANCE OF CERTAIN RECORDS
	PROHIBITED. (a) In this section, "commercial purpose" does not
	include pharmacy reimbursement, formulary compliance,
	pharmaceutical care, utilization review by a health care provider,
	or a public health activity authorized by law.
	(b)  A health benefit plan issuer or pharmacy benefit manager
	may not transfer to or receive from the issuer's or manager's
	affiliated provider a record containing patient- or
	prescriber-identifiable prescription information for a commercial
	purpose.
	Sec. 1369.554.  PROHIBITION ON CERTAIN COMMUNICATIONS. (a)
	A health benefit plan issuer or pharmacy benefit manager may not
	steer or direct a patient to use the issuer's or manager's
	affiliated provider through any oral or written communication,
	including:
	(1)  online messaging regarding the provider; or
	(2)  patient- or prospective patient-specific
	advertising, marketing, or promotion of the provider.
	(b)  This section does not prohibit a health benefit plan
	issuer or pharmacy benefit manager from including the issuer's or
	manager's affiliated provider in a patient or prospective patient
	communication, if the communication:
	(1)  is regarding information about the cost or service
	provided by pharmacies or durable medical equipment providers in
	the network of a health benefit plan in which the patient or
	prospective patient is enrolled; and
	(2)  includes accurate comparable information
	regarding pharmacies or durable medical equipment providers in the
	network that are not the issuer's or manager's affiliated
	providers.
	Sec. 1369.555.  PROHIBITION ON CERTAIN REFERRALS AND
	SOLICITATIONS. (a) A health benefit plan issuer or pharmacy
	benefit manager may not require a patient to use the issuer's or
	manager's affiliated provider in order for the patient to receive
	the maximum benefit for the service under the patient's health
	benefit plan.
	(b)  A health benefit plan issuer or pharmacy benefit manager
	may not offer or implement a health benefit plan that requires or
	induces a patient to use the issuer's or manager's affiliated
	provider, including by providing for reduced cost-sharing if the
	patient uses the affiliated provider.
	(c)  A health benefit plan issuer or pharmacy benefit manager
	may not solicit a patient or prescriber to transfer a patient
	prescription to the issuer's or manager's affiliated provider.
	(d)  A health benefit plan issuer or pharmacy benefit manager
	may not require a pharmacy or durable medical equipment provider
	that is not the issuer's or manager's affiliated provider to
	transfer a patient's prescription to the issuer's or manager's
	affiliated provider without the prior written consent of the
	patient.
	SECTION 2.  Sections 1369.555(a) and (b), Insurance Code, as
	added by this Act, apply only to a health benefit plan delivered,
	issued for delivery, or renewed on or after the effective date of
	this Act.
	SECTION 3.  This Act takes effect September 1, 2021.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I certify that H.B. No. 1919 was passed by the House on April
	29, 2021, by the following vote:  Yeas 128, Nays 16, 2 present, not
	voting; and that the House concurred in Senate amendments to H.B.
	No. 1919 on May 28, 2021, by the following vote:  Yeas 124, Nays 21,
	1 present, not voting.
	______________________________
	Chief Clerk of the House
	I certify that H.B. No. 1919 was passed by the Senate, with
	amendments, on May 24, 2021, by the following vote:  Yeas 30, Nays
	0.
	______________________________
	Secretary of the Senate
	APPROVED: __________________
	Date
	__________________
	Governor