Texas Insurance Code 1369.501 – Definitions
Terms Used In Texas Insurance Code 1369.501
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
In this subchapter:
(1) “Animal health product” means a medical product approved and licensed for use in animal or veterinary medicine, including a pharmaceutical, a biologic, an insecticide, and a parasiticide.
(2) “Health benefit plan” means an individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health benefit plan issuer in this state.
(3) “Health benefit plan issuer” means an insurance company, a health maintenance organization, or a hospital and medical service corporation.
(4) “Pharmaceutical drug manufacturer” means a person engaged in the business of producing, preparing, propagating, compounding, converting, processing, packaging, labeling, or distributing a prescription drug. The term does not include a wholesale distributor or retailer of prescription drugs or a pharmacist licensed under Subtitle J, Title 3, Occupations Code.
(5) “Pharmacy benefit manager” has the meaning assigned by § 4151.151.
(6) “Prescription drug” has the meaning assigned by § 551.003, Occupations Code, except that the term “prescription drug” does not include a device or an animal health product.
(7) “Rebate” means a discount or concession that affects the price of a prescription drug to a pharmacy benefit manager or health benefit plan issuer for a prescription drug manufactured by the pharmaceutical drug manufacturer.
(8) “Specialty drug” means a prescription drug covered under Medicare Part D that exceeds the specialty tier cost threshold established by the Centers for Medicare and Medicaid Services.
(9) “Utilization management” means a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings.
