bill extending pharmacy benefit manager rules to every plan

The text as introduced · 444 words

89R1175 SCL-F

By: Bonnen
H.B. No. 5102

A BILL TO BE ENTITLED

AN ACT

relating to applicability of certain prescription drug insurance

laws to health benefit plans and pharmacy benefit managers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter L, Chapter 1369, Insurance Code, is

amended by adding Section 1369.5515 to read as follows:

Sec. 1369.5515. APPLICABILITY OF SUBCHAPTER. (a) Except

as provided by this subsection, a pharmacy benefit manager must

comply with the provisions of this subchapter with respect to each

health benefit plan administered by the pharmacy benefit manager,

regardless of whether a provision of this subchapter is

specifically made applicable to the plan. A pharmacy benefit

manager is not required to comply with a provision of this

subchapter with respect to a plan expressly excluded by this

subchapter from the applicability of the provision.

(b) This subchapter applies to a health benefit plan

provided to a resident of this state, regardless of whether the

plan, policy, agreement, or contract is delivered, issued for

delivery, or renewed within or outside this state and to the

pharmacy benefit manager for that plan.

SECTION 2. Section 1369.602, Insurance Code, is amended by

adding Subsections (d) and (e) to read as follows:

(d) Except as provided by this subsection, a pharmacy

benefit manager must comply with the provisions of this subchapter

with respect to each health benefit plan administered by the

pharmacy benefit manager, regardless of whether a provision of this

subchapter is specifically made applicable to the plan. A pharmacy

benefit manager is not required to comply with a provision of this

subchapter with respect to a plan expressly excluded by this

subchapter from the applicability of the provision.

(e) This subchapter applies to a health benefit plan

provided to a resident of this state, regardless of whether the

plan, policy, agreement, or contract is delivered, issued for

delivery, or renewed within or outside this state and to the

pharmacy benefit manager for that plan.

SECTION 3. As soon as practicable after the effective date

of this Act, the commissioner of insurance shall repeal all rules

that are inconsistent with the changes in law made by this Act.

SECTION 4. The changes in law made by this Act apply only to

a health benefit plan that is delivered, issued for delivery, or

renewed on or after January 1, 2026. A health benefit plan

delivered, issued for delivery, or renewed before January 1, 2026,

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 5. This Act takes effect September 1, 2025.