Texas § IN.1369.501 - DEFINITIONS

§ IN.1369.501. DEFINITIONS

DEFINITIONS. In this subchapter: (1) "Animal health product" means a medical product approved and licensed for use in animal or veterinary medicine, including a pharmaceutical, a biologic, an insecticide, and a parasiticide. (2) "Health benefit plan" means an individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health benefit plan issuer in this state. (3) "Health benefit plan issuer" means an insurance company, a health maintenance organization, or a hospital and medical service corporation. (4) "Pharmaceutical drug manufacturer" means a person engaged in the business of producing, preparing, propagating, compounding, converting, processing, packaging, labeling, or distributing a prescription drug. The term does not include a wholesale distributor or retailer of prescription drugs or a pharmacist licensed under Subtitle J, Title 3, Occupations Code. (5) "Pharmacy benefit manager" has the meaning assigned by Section 4151.151 . (6) "Prescription drug" has the meaning assigned by Section 551.003 , Occupations Code, except that the term "prescription drug" does not include a device or an animal health product. (7) "Rebate" means a discount or concession that affects the price of a prescription drug to a pharmacy benefit manager or health benefit plan issuer for a prescription drug manufactured by the pharmaceutical drug manufacturer. (8) "Specialty drug" means a prescription drug covered under Medicare Part D that exceeds the specialty tier cost threshold established by the Centers for Medicare and Medicaid Services. (9) "Utilization management" means a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings. Added by Acts 2019, 86th Leg., R.S., Ch. 1291 (H.B. 2536 ), Sec. 2, eff. September 1, 2019.