Relating to protection of certain disclosures and communications by pharmacists and pharmacies regarding prescription drug benefits.
Summary
SB 493 amends the Texas Insurance Code to limit the ability of pharmacy benefit managers (PBMs) to prevent pharmacists and pharmacies from sharing certain pricing and benefit information with patients and plan sponsors. The bill specifically protects a pharmacist’s or pharmacy’s right to tell an enrollee when the patient’s out-of-pocket cost for a prescription drug would differ if the claim were not submitted through the enrollee’s prescription drug benefit. It also protects communications with plan sponsors or administrators about member services, prescription drug benefits, pharmacy services, network access and adequacy, partnership opportunities, and prescription claim reimbursement.
The bill makes any pharmacy benefit network contract provision void and unenforceable if it restricts those protected disclosures or communications. In practical terms, SB 493 is a “gag clause” prohibition measure aimed at increasing transparency in prescription drug pricing and pharmacy-benefit relationships. The law applies only to contracts or agreements entered into, amended, or renewed on or after the effective date, and it takes effect September 1, 2025.
Impact
SB 493 adds new Section 4151.155 to Chapter 4151 of the Insurance Code, creating a statutory limit on PBM contract terms that silence pharmacists or pharmacies. It affects pharmacy benefit managers, pharmacies, pharmacists, health plan sponsors, administrators, and enrollees in prescription drug benefit plans by ensuring patients can be informed of lower cash prices and by allowing broader communications about network and reimbursement issues. Existing contracts are not immediately altered unless they are entered into, amended, or renewed on or after the effective date.
Sentiment
The bill appears to have been broadly supported and noncontroversial. It passed the Senate unanimously and the House overwhelmingly, with 147 yeas, no nays, and two present not voting, and the Senate later concurred in the House amendment without recorded opposition. The vote pattern suggests strong bipartisan agreement around increasing transparency in prescription drug pricing and pharmacy communications.
Contention
No major opposition is reflected in the available record, and there are no committee transcript excerpts indicating substantive debate. The main policy issue underlying the bill is the balance between PBM contract control and pharmacists’ ability to disclose pricing differences and communicate with plan sponsors. Any potential contention would likely center on PBM network management and contract enforcement versus consumer transparency and pharmacy autonomy, but the legislative record provided does not show active dispute.
Authorizes pharmacists to dispense HIV prophylaxis without individual prescription under certain circumstances; mandates prescription benefits coverage.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a sixty-day (60) supply may be dispensed at any one time.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a ninety-day (90) supply may be dispensed at any one time.