Tex. Insurance Code § 1369.555
PROHIBITION ON CERTAIN REFERRALS AND SOLICITATIONS
Texas · Texas Insurance Code · Status: effective
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- Citation
- Tex. Insurance Code § 1369.555, PROHIBITION ON CERTAIN REFERRALS AND SOLICITATIONS, Texas, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/682272
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Full text
(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.