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Relating to certain prohibited practices for certain health benefit plan issuers and certain required and prohibited practices for certain pharmacy benefit managers.
No significant fiscal implication to the State is anticipated.
HB 1919 would prohibit a health benefit plan issuer or pharmacy benefit manager from requiring a patient to use an affiliated pharmacy in order for the patient to receive the maximum benefit for the service, offering or implementing a health benefit plan that requires or induces a patient to use an affiliated pharmacy, soliciting a patient or prescriber to transfer a patient prescription to an affiliated pharmacy or requiring a nonaffiliated pharmacy to transfer a patient’s prescription to an affiliated pharmacy without the prior written consent of the patient.
The bill would also prohibit a pharmacy benefit manager from transferring to or receiving from an affiliated pharmacy a record containing patient- or prescriber- identifiable prescription information for a commercial purpose.
HB 1919 would prohibit a health benefit plan issuer or pharmacy benefit manager from requiring a clinician-administered drug to be dispensed by a pharmacy, including by an affiliated provider, or be covered as a pharmacy benefit rather than a medical benefit, when dealing with cancer patients.
HB 1919 would not apply to the state Medicaid program, the child health plan program, the TRICARE military health system, and other certain coverage plans.
Texas Action opposes HB 1919 because it violates the free market and individual liberty principles. While practices described above can seem unfair or annoying, a health benefit plan issuer or pharmacy benefit manager have the right to tailor plans that make themselves more attractive to consumers, and consumers have the right to choose those kinds of plans or opt out of them.
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