Texas

Quick Facts

Key Provisions

• DPC Is Not Insurance: Under Texas Occupations Code §162.252, a DPC agreement is not considered an insurance plan, and a physician providing DPC is not classified as an insurer. This exempts DPC practices from the complex and costly regulations overseen by the Texas Department of Insurance.
• Provider Eligibility is Limited: The law specifically applies to physicians (MDs and DOs) licensed under Texas law and their wholly owned professional associations or PLLCs. It does not extend to other providers like Nurse Practitioners or Physician Assistants, who cannot independently establish a DPC practice under this statute.
• Written Agreement Required: A DPC relationship must be formalized through a signed, written 'medical service agreement' between the physician and the patient (or their representative, like an employer). This agreement must be for a defined period of time.
• Protection from Interference: The law (Texas Occupations Code §162.253) prohibits the Texas Medical Board, other state agencies, insurance carriers, and HMOs from penalizing or interfering with physicians or patients for entering into a DPC arrangement.
• Definition of 'Direct Fee': The statute defines a 'direct fee' as a recurring fee paid for primary care services. It explicitly excludes fees based on a percentage of charges, traditional capitation, or per-visit/per-service billing models.
• No Mandated Fee or Term Limits: The Texas DPC law provides significant operational flexibility. It does not impose any caps on membership fees, dictate fee schedules, or mandate specific contract termination or refund policies, leaving these details to the physician-patient agreement.
• Broad Definition of Primary Care: The law defines 'primary medical care service' broadly to include health promotion, disease prevention, screening, diagnosis, treatment of acute and chronic conditions, counseling, and education, confirming that DPC covers a wide range of routine healthcare.

Medication Dispensing

The Texas DPC statute (Subchapter F, Chapter 162 of the Occupations Code) does not contain specific provisions regarding in-office medication dispensing. However, DPC practices in Texas can dispense medications by following the state's general laws governing physician dispensing. Under Texas Occupations Code §158.003, a physician is permitted to supply drugs to their own patients to meet their immediate needs, provided the drugs are dispensed in the physician's office. Physicians who dispense must comply with all labeling, packaging, and record-keeping requirements established by the Texas State Board of Pharmacy, just as a traditional pharmacy would. This allows DPC clinics to offer the convenience of wholesale medications to their patients without needing a separate pharmacy license, as long as they adhere to these established regulations.