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Insurance Code §1369.555

Text in force on

In force on Sep 01, 2021 · this text took effect Sep 01, 2021 · same as today's text

PROHIBITION ON CERTAIN REFERRALS AND SOLICITATIONS

(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. (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.

History: Added by Acts 2021, 87th Leg., R.S., Ch. 1012 (H.B. 1919 ), Sec. 1, eff. September 1, 2021.

Source: the Legislature's file server, seen Nov 08, 2026.

Every version on file

A research copy. The official text is the Legislature's (statutes), the Secretary of State's (Texas Administrative Code) or eCFR's (federal rules). Not legal advice.