bill barring insurers from forcing their own PBM

The text as introduced · 473 words

89R12314 SCF-F

By: Harris
H.B. No. 2750

A BILL TO BE ENTITLED

AN ACT

relating to use of a pharmacy benefit manager in which a health

benefit plan issuer has a financial interest.

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. USE OF CERTAIN PHARMACY BENEFIT MANAGERS

Sec. 1369.801. DEFINITIONS. In this subchapter:

(1) "Financial interest" means an ownership or

investment interest through equity, debt, or other means, including

an interest in an entity that holds an ownership or investment

interest.

(2) "Pharmacy benefit manager" has the meaning

assigned by Section 4151.151.

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) 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; and

(9) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code.

Sec. 1369.803. PROHIBITION ON REQUIRING USE OF CERTAIN

PHARMACY BENEFIT MANAGERS. A health benefit plan issuer that has a

financial interest in a pharmacy benefit manager may not require an

enrollee to use the pharmacy benefit manager.

SECTION 2. Subchapter R, Chapter 1369, Insurance Code, as

added by this Act, applies only to a health benefit plan delivered,

issued for delivery, or renewed on or after January 1, 2026.

SECTION 3. This Act takes effect September 1, 2025.