Bill Text: TX SB846 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the contractual relationship between a pharmacist or pharmacy and a health benefit plan issuer or pharmacy benefit manager.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2019-03-13 - Co-author authorized [SB846 Detail]
Download: Texas-2019-SB846-Introduced.html
| 86R2805 JES-F | ||
| By: Hughes | S.B. No. 846 | |
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| 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 K to read as follows: | ||
| SUBCHAPTER K. CONTRACTS WITH PHARMACISTS AND PHARMACIES | ||
| Sec. 1369.501. DEFINITIONS. In this subchapter: | ||
| (1) "Pharmacy benefit manager" means a person, other | ||
| than a pharmacist or pharmacy, who acts as an administrator in | ||
| connection with pharmacy benefits. | ||
| (2) "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. 1369.502. 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 chapter 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; | ||
| (6) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (7) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (8) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| Sec. 1369.503. PERFORMANCE MEASURES AND RELATED FEES. (a) | ||
| A health benefit plan issuer or pharmacy benefit manager that | ||
| establishes a contractual pharmacy performance measure or pay for | ||
| performance pharmacy network shall evaluate the performance of | ||
| pharmacists or pharmacies for purposes of that measure or network | ||
| using a nationally recognized performance information management | ||
| tool that provides standardized, benchmarked data to improve | ||
| pharmacy performance. | ||
| (b) A health benefit plan issuer or pharmacy benefit manager | ||
| may not directly or indirectly charge or hold a pharmacist or | ||
| pharmacy responsible for a fee if: | ||
| (1) the pharmacist or pharmacy uses the performance | ||
| information management tool described by Subsection (a) to produce | ||
| a score or metric for patient care; and | ||
| (2) the score or metric is within the criteria | ||
| identified by the health benefit plan issuer or pharmacy benefit | ||
| manager using the data provided by the performance information | ||
| management tool. | ||
| (c) If a health benefit plan issuer or pharmacy benefit | ||
| manager imposes a fee on a pharmacist or pharmacy based on a score | ||
| or metric produced by the performance information management tool | ||
| described by Subsection (a), the health benefit plan issuer or | ||
| pharmacy benefit manager: | ||
| (1) may recover the fee as an offset against the | ||
| professional dispensing fee owed under the contract with the | ||
| pharmacist or pharmacy; and | ||
| (2) may not recover the fee as an offset against any | ||
| other amount owed to the pharmacist or pharmacy under the contract. | ||
| Sec. 1369.504. 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 a copy of the contract. | ||
| Sec. 1369.505. DELIVERY OF DRUGS. 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 drugs to a patient as an | ||
| ancillary service of the pharmacist or pharmacy as otherwise | ||
| allowed by law; or | ||
| (2) charging a shipping and handling fee to a patient | ||
| requesting a prescription be mailed or delivered. | ||
| Sec. 1369.506. 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 | ||
| for licensure as a pharmacist or pharmacy in this state; or | ||
| (2) prohibit a licensed pharmacist or pharmacy from | ||
| dispensing any drug that may be dispensed under the pharmacist's or | ||
| pharmacy's license. | ||
| Sec. 1369.507. WAIVER PROHIBITED. The provisions of this | ||
| subchapter may not be waived, voided, or nullified by contract. | ||
| Sec. 1369.508. UNFAIR OR DECEPTIVE ACT OR PRACTICE. A | ||
| violation of this subchapter by a health benefit plan issuer or | ||
| pharmacy benefit manager is an unfair or deceptive act or practice | ||
| in the business of insurance under Chapter 541. | ||
| 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, 2019. | ||
