# Tex. Insurance Code § 1369.051: DEFINITIONS

> Texas · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.051

## Section

- **Citation:** Tex. Insurance Code § 1369.051
- **Heading:** DEFINITIONS
- **Jurisdiction:** Texas
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** TX Code / Code in / Chapter 1369 / Section 1369.051

## Text

In this subchapter:

(1) "Clinical practice guideline" means a statement systematically developed by a multidisciplinary panel of experts composed of physicians and, as necessary, other health care providers to assist a patient or health care provider in making a decision about appropriate health care for a specific clinical circumstance or condition.

(1-a) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols, and clinical practice guidelines used by a health benefit plan issuer, utilization review organization, or independent review organization to determine the medical necessity and appropriateness or the experimental or investigational nature of a health care service or prescription drug.

(1-b) "Drug formulary" means a list of drugs:

(A) for which a health benefit plan provides coverage;

(B) for which a health benefit plan issuer approves payment; or

(C) that a health benefit plan issuer encourages or offers incentives for physicians to prescribe.

(2) "Enrollee" means an individual who is covered under a health benefit plan, including a covered dependent.

(3) "Physician" means a person licensed as a physician by the Texas State Board of Medical Examiners.

(4) "Prescription drug" has the meaning assigned by Section 551.003, Occupations Code.

(5) "Step therapy protocol" means a protocol that requires an enrollee to use a prescription drug or sequence of prescription drugs other than the drug that the enrollee's physician recommends for the enrollee's treatment before the health benefit plan provides coverage for the recommended drug.

## Nearby sections

- [Tex. Insurance Code § 1369.001 § 1369.001. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.001.md)
- [Tex. Insurance Code § 1369.002 § 1369.002. APPLICABILITY OF SUBCHAPTER.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.002.md)
- [Tex. Insurance Code § 1369.003 § 1369.003. EXCEPTION.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.003.md)
- [Tex. Insurance Code § 1369.004 § 1369.004. COVERAGE REQUIRED.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.004.md)
- [Tex. Insurance Code § 1369.005 § 1369.005. RULES.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.005.md)
- [Tex. Insurance Code § 1369.0041 § 1369.0041. CERTAIN PAYMENTS AND REFILLS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.0041.md)
- [Tex. Insurance Code § 1369.051 § 1369.051. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.051.md)
- [Tex. Insurance Code § 1369.052 § 1369.052. APPLICABILITY OF SUBCHAPTER.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.052.md)
- [Tex. Insurance Code § 1369.053 § 1369.053. EXCEPTION.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.053.md)
- [Tex. Insurance Code § 1369.054 § 1369.054. NOTICE AND DISCLOSURE OF CERTAIN INFORMATION REQUIRED.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.054.md)
- [Tex. Insurance Code § 1369.055 § 1369.055. CONTINUATION OF COVERAGE REQUIRED; OTHER DRUGS NOT PRECLUDED.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.055.md)
- [Tex. Insurance Code § 1369.056 § 1369.056. ADVERSE DETERMINATION.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.056.md)
- [Tex. Insurance Code § 1369.057 § 1369.057. RULES.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.057.md)
- [Tex. Insurance Code § 1369.076 § 1369.076. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.076.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1369_S1369.051. Check the current official text before relying on it. Not legal advice.