Tex. Ins. Code Section 1369.001
Definitions


In this subchapter:

(1)

“Contraindication” means the potential for, or the occurrence of:

(A)

an undesirable change in the therapeutic effect of a prescribed drug because of the presence of a disease condition in the patient for whom the drug is prescribed; or

(B)

a clinically significant adverse effect of a prescribed drug on a disease condition of the patient for whom the drug is prescribed.

(2)

“Drug” has the meaning assigned by Section 551.003 (Definitions), Occupations Code.

(2-a)

“Enrollee” means an individual who is covered under a health benefit plan, including a covered dependent.

(3)

“Indication” means a symptom, cause, or occurrence in a disease that points out the cause, diagnosis, course of treatment, or prognosis of the disease.

(4)

“Peer-reviewed medical literature” means scientific studies published in a peer-reviewed national professional journal.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 727 (S.B. 1076), Sec. 1, eff. September 1, 2017.

Source: Section 1369.001 — Definitions, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1369.­htm#1369.­001 (accessed Nov. 25, 2023).

1369.001
Definitions
1369.002
Applicability of Subchapter
1369.003
Exception
1369.004
Coverage Required
1369.005
Rules
1369.0041
Certain Payments and Refills
1369.051
Definitions
1369.052
Applicability of Subchapter
1369.053
Exception
1369.054
Notice and Disclosure of Certain Information Required
1369.055
Continuation of Coverage Required
1369.056
Adverse Determination
1369.057
Rules
1369.076
Definitions
1369.077
Applicability of Subchapter
1369.078
Formulary Information on Internet Website
1369.079
Formulary Disclosure Requirements
1369.080
Formulary Information Provided by Toll-free Telephone Number
1369.091
Definitions
1369.092
Applicability of Subchapter
1369.093
Exceptions to Applicability of Subchapter
1369.094
Disclosure of Prescription Drug Information
1369.101
Definitions
1369.102
Applicability of Subchapter
1369.103
Exception
1369.104
Exclusion or Limitation Prohibited
1369.105
Certain Cost-sharing Provisions Prohibited
1369.106
Certain Waiting Periods Prohibited
1369.107
Prohibited Conduct
1369.108
Exemption for Entities Associated with Religious Organization
1369.109
Enforcement
1369.151
Applicability of Subchapter
1369.152
Exception
1369.153
Information Required on Identification Card
1369.154
Rules
1369.201
Definitions
1369.202
Applicability of Subchapter
1369.203
Exception
1369.204
Required Coverage for Orally Administered Anticancer Medications
1369.211
Definitions
1369.212
Applicability of Subchapter
1369.213
Prohibited Conduct
1369.251
Definitions
1369.252
Exceptions to Applicability of Subchapter
1369.253
Conflict with Other Laws
1369.254
Audit of Pharmacist or Pharmacy
1369.255
Completion of Audit
1369.256
Audit Requiring Professional Judgment
1369.257
Access to Pharmacy Area
1369.258
Validation Using Certain Records Authorized
1369.259
Calculation of Recoupment
1369.260
Clerical or Recordkeeping Error
1369.261
Access to Previous Audit Reports
1369.262
Compensation of Auditor
1369.263
Conclusion of Audit
1369.264
Final Audit Report
1369.265
Certain Audits Exempt from Deadlines
1369.266
Recoupment and Interest Charged After Audit
1369.267
Waiver Prohibited
1369.268
Remedies Not Exclusive
1369.269
Enforcement
1369.270
Legislative Declaration
1369.301
Definition
1369.302
Applicability of Subchapter
1369.303
Exception
1369.304
Standard Form
1369.305
Advisory Committee on Uniform Prior Authorization Forms
1369.306
Failure to Use or Acknowledge Standard Form
1369.351
Definitions
1369.352
Certain Benefits Excluded
1369.353
Criteria for Drugs on Maximum Allowable Cost Lists
1369.354
Formulation of Maximum Allowable Costs
1369.355
Updates
1369.356
Access to Maximum Allowable Cost Lists
1369.357
Appeal from Maximum Allowable Cost Price Determination
1369.358
Confidentiality of Maximum Allowable Cost List
1369.359
Waiver Prohibited
1369.360
Remedies Not Exclusive
1369.361
Enforcement
1369.362
Legislative Declaration
1369.401
Definition
1369.402
Certain Fees Prohibited
1369.451
Definitions
1369.452
Applicability of Subchapter
1369.453
Applicability to Certain Medications
1369.454
Proration of Cost-sharing Amount Required
1369.455
Proration of Dispensing Fee Prohibited
1369.456
Implementation of Certain Medication Synchronization Plans
1369.501
Definitions
1369.502
Pharmacy Benefit Manager Information
1369.503
Health Benefit Plan Issuer Information
1369.504
Rules
1369.0541
Modification of Drug Coverage Under Plan
1369.0542
Effect of Reductions in Out-of-pocket Expenses on Cost Sharing
1369.0545
Step Therapy Protocols
1369.0546
Step Therapy Protocol Exception Requests
1369.0547
Step Therapy Protocols for Prescription Drugs to Treat Serious Mental Illnesses
1369.551
Definitions
1369.552
Exceptions to Applicability of Subchapter
1369.553
Transfer or Acceptance of Certain Records Prohibited
1369.554
Prohibition on Certain Communications
1369.555
Prohibition on Certain Referrals and Solicitations
1369.601
Definitions
1369.602
Applicability of Subchapter
1369.603
Reduction of Certain Claim Payment Amounts Prohibited
1369.604
Reimbursement of Affiliated and Nonaffiliated Pharmacists and Pharmacies
1369.605
Network Contract Fee Schedule
1369.606
Disclosure of Pharmacy Services Administrative Organization Contract
1369.607
Delivery of Drugs
1369.608
Professional Standards and Scope of Practice Requirements
1369.609
Retaliation Prohibited
1369.610
Waiver Prohibited
1369.651
Definition
1369.652
Applicability of Subchapter
1369.653
Exceptions
1369.654
Prohibition on Multiple Prior Authorizations
1369.761
Definitions
1369.762
Applicability of Subchapter
1369.763
Exceptions to Applicability of Subchapter
1369.764
Certain Limitations on Coverage of Clinician-administered Drugs Prohibited
1369.1031
Certain Coverage Required
1369.2581
Audit Discrepancies
1369.5035
Content of Reports

Accessed:
Nov. 25, 2023

§ 1369.001’s source at texas​.gov