| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the application of prescription drug price reductions; |
|
|
imposing a civil penalty. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Chapter 1369, Insurance Code, is amended by |
|
|
adding Subchapter B-3 to read as follows: |
|
|
SUBCHAPTER B-3. PRESCRIPTION DRUG PRICE REDUCTIONS |
|
|
Sec. 1369.095. DEFINITIONS. In this subchapter: |
|
|
(1) "Manufacturer" means a person who is engaged in |
|
|
making, preparing, propagating, fabricating, compounding, |
|
|
processing, packaging, repackaging, labeling or relabeling of a |
|
|
prescription drug or biological product. |
|
|
(2) "Pharmacy benefit manager" and "prescription |
|
|
drug" have the meanings assigned by Section 1369.501. |
|
|
Sec. 1369.096. 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) group health coverage made available by a school |
|
|
district in accordance with Section 22.004, Education Code; |
|
|
(8) a regional or local health care program operated |
|
|
under Section 75.104, Health and Safety Code; |
|
|
(9) a self-funded health benefit plan sponsored by a |
|
|
professional employer organization under Chapter 91, Labor Code; |
|
|
(10) county employee group health benefits provided |
|
|
under Chapter 157, Local Government Code; and |
|
|
(11) health and accident coverage provided by a risk |
|
|
pool created under Chapter 172, Local Government Code. |
|
|
Sec. 1369.097. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER. |
|
|
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 under Chapter 540, Government Code; |
|
|
(2) the child health plan program under Chapter 62, |
|
|
Health and Safety Code; |
|
|
(3) the TRICARE military health system; or |
|
|
Statutes affected:
Introduced: ()
|