By: Oliverson, Hefner, Lucio III,	H.B. No. 1763
	Bell of Montgomery, Raymond, et al.

	A BILL TO BE ENTITLED
	AN ACT
	relating to the contractual relationship between a pharmacist or
	pharmacy and a health benefit plan issuer or pharmacy benefit
	manager.
	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. CONTRACTS WITH PHARMACISTS AND PHARMACIES
	Sec. 1369.551.  DEFINITIONS. In this subchapter:
	(1)  "Pharmacy benefit manager" has the meaning
	assigned by Section 4151.151.
	(2)  "Pharmacy benefit network" means a network of
	pharmacies that have contracted with a pharmacy benefit manager to
	provide pharmacist services to enrollees.
	(3)  "Pharmacy services administrative organization"
	means an entity that contracts with a pharmacist or pharmacy to
	conduct on behalf of the pharmacist or pharmacy the pharmacist's or
	pharmacy's business with a third-party payor, including a pharmacy
	benefit manager, in connection with pharmacy benefits and to assist
	the pharmacist or pharmacy by providing administrative services,
	including negotiating, executing, and administering a contract
	with a third-party payor and communicating with the third-party
	payor in connection with a contract or pharmacy benefits.
	Sec. 1369.552.  APPLICABILITY OF SUBCHAPTER. (a) This
	subchapter applies only to a health benefit plan that provides
	benefits for medical or surgical expenses incurred as a result of a
	health condition, accident, or sickness, including an individual,
	group, blanket, or franchise insurance policy or insurance
	agreement, a group hospital service contract, or an individual or
	group evidence of coverage or similar coverage document that is
	offered by:
	(1)  an insurance company;
	(2)  a group hospital service corporation operating
	under Chapter 842;
	(3)  a health maintenance organization operating under
	Chapter 843;
	(4)  an approved nonprofit health corporation that
	holds a certificate of authority under Chapter 844;
	(5)  a multiple employer welfare arrangement that holds
	a certificate of authority under Chapter 846;
	(6)  a stipulated premium company operating under
	Chapter 884;
	(7)  a fraternal benefit society operating under
	Chapter 885;
	(8)  a Lloyd's plan operating under Chapter 941; or
	(9)  an exchange operating under Chapter 942.
	(b)  Notwithstanding any other law, this subchapter applies
	to:
	(1)  a small employer health benefit plan subject to
	Chapter 1501, including coverage provided through a health group
	cooperative under Subchapter B of that chapter;
	(2)  a standard health benefit plan issued under
	Chapter 1507;
	(3)  health benefits provided by or through a church
	benefits board under Subchapter I, Chapter 22, Business
	Organizations Code;
	(4)  group health coverage made available by a school
	district in accordance with Section 22.004, Education Code;
	(5)  a regional or local health care program operated
	under Section 75.104, Health and Safety Code; and
	(6)  a self-funded health benefit plan sponsored by a
	professional employer organization under Chapter 91, Labor Code.
	(c)  This subchapter does not apply to an issuer or provider
	of health benefits under or a pharmacy benefit manager
	administering pharmacy benefits under a workers' compensation
	insurance policy or other form of providing medical benefits under
	Title 5, Labor Code.
	Sec. 1369.553.  REDUCTION OF CERTAIN CLAIM PAYMENT AMOUNTS
	PROHIBITED. (a) A health benefit plan issuer or pharmacy benefit
	manager may not directly or indirectly reduce the amount of a claim
	payment to a pharmacist or pharmacy after adjudication of the claim
	through the use of an aggregated effective rate, quality assurance
	program, other direct or indirect remuneration fee, or otherwise,
	except in accordance with an audit performed under Subchapter F.
	(b)  Nothing in this section prohibits a health benefit plan
	issuer or pharmacy benefit manager from increasing a claim payment
	amount after adjudication of the claim.
	Sec. 1369.554.  REIMBURSEMENT OF AFFILIATED AND
	NONAFFILIATED PHARMACISTS AND PHARMACIES. (a) In this section:
	(1)  "Affiliated pharmacist or pharmacy" means a
	pharmacist or pharmacy that directly, or indirectly through one or
	more intermediaries, controls or is controlled by, or is under
	common control with, a pharmacy benefit manager.
	(2)  "Nonaffiliated pharmacist or pharmacy" means a
	pharmacist or pharmacy that does not directly, or indirectly
	through one or more intermediaries, control and is not controlled
	by or under common control with a pharmacy benefit manager.
	(b)  A pharmacy benefit manager may not pay an affiliated
	pharmacist or pharmacy a reimbursement amount that is more than the
	amount the pharmacy benefit manager pays a nonaffiliated pharmacist
	or pharmacy for the same pharmacist service.
	Sec. 1369.555.  NETWORK CONTRACT FEE SCHEDULE. A pharmacy
	benefit network contract must specify or reference a separate fee
	schedule. Unless otherwise available in the contract, the fee
	schedule must be provided electronically in an easily accessible
	and complete spreadsheet format and, on request, in writing to each
	contracted pharmacist and pharmacy. The fee schedule must
	describe:
	(1)  specific services or procedures that the
	pharmacist or pharmacy may deliver and the amount of the
	corresponding payment;
	(2)  a methodology for calculating the amount of the
	payment based on a published fee schedule; or
	(3)  any other reasonable manner that provides an
	ascertainable amount for payment for services.
	Sec. 1369.556.  DISCLOSURE OF PHARMACY SERVICES
	ADMINISTRATIVE ORGANIZATION CONTRACT. A pharmacist or pharmacy
	that is a member of a pharmacy services administrative organization
	that enters into a contract with a health benefit plan issuer or
	pharmacy benefit manager on the pharmacist's or pharmacy's behalf
	is entitled to receive from the pharmacy services administrative
	organization a copy of the contract provisions applicable to the
	pharmacist or pharmacy, including each provision relating to the
	pharmacist's or pharmacy's rights and obligations under the
	contract.
	Sec. 1369.557.  DELIVERY OF DRUGS. (a) Except in a case in
	which the health benefit plan issuer or pharmacy benefit manager
	makes a credible allegation of fraud against the pharmacist or
	pharmacy and provides reasonable notice of the allegation and the
	basis of the allegation to the pharmacist or pharmacy, a health
	benefit plan issuer or pharmacy benefit manager may not as a
	condition of a contract with a pharmacist or pharmacy prohibit the
	pharmacist or pharmacy from:
	(1)  mailing or delivering a drug to a patient on the
	patient's request, to the extent permitted by law; or
	(2)  charging a shipping and handling fee to a patient
	requesting a prescription be mailed or delivered if the pharmacist
	or pharmacy discloses to the patient before the delivery:
	(A)  the fee that will be charged; and
	(B)  that the fee may not be reimbursable by the
	health benefit plan issuer or pharmacy benefit manager.
	(b)  A pharmacist or pharmacy may not charge a health benefit
	plan issuer or pharmacy benefit manager for the delivery of a
	prescription drug as described by this section unless the charge is
	specifically agreed to by the health benefit plan issuer or
	pharmacy benefit manager.
	Sec. 1369.558.  PROFESSIONAL STANDARDS AND SCOPE OF PRACTICE
	REQUIREMENTS. A health benefit plan issuer or pharmacy benefit
	manager may not as a condition of a contract with a pharmacist or
	pharmacy:
	(1)  require pharmacist or pharmacy accreditation
	standards or recertification requirements inconsistent with, more
	stringent than, or in addition to federal and state requirements;
	or
	(2)  prohibit a licensed pharmacist or pharmacy from
	dispensing any drug that may be dispensed under the pharmacist's or
	pharmacy's license unless:
	(A)  applicable state or federal law prohibits the
	pharmacist or pharmacy from dispensing the drug; or
	(B)  the manufacturer of the drug requires that a
	pharmacist or pharmacy possess one or more accreditations or
	certifications to dispense the drug and the pharmacist or pharmacy
	does not meet the requirement.
	Sec. 1369.559.  RETALIATION PROHIBITED. (a) A pharmacy
	benefit manager may not retaliate against a pharmacist or pharmacy
	based on the pharmacist's or pharmacy's exercise of any right or
	remedy under this chapter. Retaliation prohibited by this section
	includes:
	(1)  terminating or refusing to renew a contract with
	the pharmacist or pharmacy;
	(2)  subjecting the pharmacist or pharmacy to increased
	audits; or
	(3)  failing to promptly pay the pharmacist or pharmacy
	any money owed by the pharmacy benefit manager to the pharmacist or
	pharmacy.
	(b)  For purposes of this section, a pharmacy benefit manager
	is not considered to have retaliated against a pharmacist or
	pharmacy if the pharmacy benefit manager:
	(1)  takes an action in response to a credible
	allegation of fraud against the pharmacist or pharmacy; and
	(2)  provides reasonable notice to the pharmacist or
	pharmacy of the allegation of fraud and the basis of the allegation
	before taking the action.
	Sec. 1369.560.  WAIVER PROHIBITED. The provisions of this
	subchapter may not be waived, voided, or nullified by contract.
	SECTION 2.  The change in law made by this Act applies only
	to a contract entered into or renewed on or after the effective date
	of this Act. A contract entered into or renewed before the
	effective date of this Act is governed by the law as it existed
	immediately before the effective date of this Act, and that law is
	continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2021.