Bill Text: TX SB493 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to certain protected disclosures by pharmacists and pharmacies regarding amounts charged for prescription drugs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2024-11-22 - Filed [SB493 Detail]
Download: Texas-2025-SB493-Introduced.html
| 89R5182 DNC-D | ||
| By: Kolkhorst | S.B. No. 493 | |
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| relating to certain protected disclosures by pharmacists and | ||
| pharmacies regarding amounts charged for prescription drugs. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter R to read as follows: | ||
| SUBCHAPTER R. PROTECTED PRACTICES REGARDING PRESCRIPTION DRUG | ||
| CHARGES | ||
| Sec. 1369.801. DEFINITIONS. In this subchapter: | ||
| (1) "Enrollee" means an individual who is covered | ||
| under a health benefit plan, including a covered dependent. | ||
| (2) "Prescription drug" has the meaning assigned by | ||
| Section 551.003, Occupations Code. | ||
| Sec. 1369.802. 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 | ||
| issued 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) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (9) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 540, Government Code; | ||
| (10) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (11) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (12) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (13) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (14) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| (c) This subchapter applies to coverage under a group health | ||
| benefit plan provided to a resident of this state regardless of | ||
| whether the group policy, agreement, or contract is delivered, | ||
| issued for delivery, or renewed in this state. | ||
| Sec. 1369.803. PROTECTED DISCLOSURE BY PHARMACISTS AND | ||
| PHARMACIES. An issuer of a health benefit plan that provides | ||
| prescription drug benefits or a pharmacy benefit manager that | ||
| administers pharmacy benefits may not, by contract or otherwise, | ||
| prohibit or restrict a pharmacist or pharmacy from informing an | ||
| enrollee of any difference between the enrollee's out-of-pocket | ||
| cost for a prescription drug under the enrollee's health benefit | ||
| plan and the out-of-pocket cost without submitting a claim under | ||
| the enrollee's health benefit plan. | ||
| SECTION 2. If before implementing any provision of this Act | ||
| a state agency determines that a waiver or authorization from a | ||
| federal agency is necessary for implementation of that provision, | ||
| the agency affected by the provision shall request the waiver or | ||
| authorization and may delay implementing that provision until the | ||
| waiver or authorization is granted. | ||
| SECTION 3. This Act takes effect September 1, 2025. | ||
