Texas Insurance Code 1369.555 – Prohibition On Certain Referrals and Solicitations
Current as of: 2024 | Check for updates
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(a) A health benefit plan issuer or pharmacy benefit manager may not require a patient to use the issuer’s or manager’s affiliated provider in order for the patient to receive the maximum benefit for the service under the patient’s health benefit plan.
(b) A health benefit plan issuer or pharmacy benefit manager may not offer or implement a health benefit plan that requires or induces a patient to use the issuer’s or manager’s affiliated provider, including by providing for reduced cost-sharing if the patient uses the affiliated provider.
Terms Used In Texas Insurance Code 1369.555
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005
(c) A health benefit plan issuer or pharmacy benefit manager may not solicit a patient or prescriber to transfer a patient prescription to the issuer’s or manager’s affiliated provider.
(d) A health benefit plan issuer or pharmacy benefit manager may not require a pharmacy or durable medical equipment provider that is not the issuer’s or manager’s affiliated provider to transfer a patient’s prescription to the issuer’s or manager’s affiliated provider without the prior written consent of the patient.
