Texas Senate Bill SB523

Texas 2021 - 87th Regular

Caption

Relating to the effect of certain reductions in a health benefit plan enrollee's out-of-pocket expenses for prescription drugs on enrollee cost-sharing requirements.

Impact

The implementation of SB523 is expected to enhance the financial transparency and fairness for enrollees in health plans by ensuring that they receive full benefits from any financial assistance available to them. By requiring health benefit plans and pharmacy benefit managers to account for any out-of-pocket expense reductions, the bill supports enrollees in managing the costs associated with their prescription medications. This change could potentially lead to increased accessibility to necessary medications for those facing high out-of-pocket costs.

Summary

SB523 introduces a modification in how reductions in out-of-pocket expenses for prescription drugs are applied within health benefit plans. The bill mandates that any financial assistance, discounts, or vouchers that lower an enrollee's out-of-pocket costs must also be applied to the enrollee's deductible and overall cost-sharing requirements. This aims to make sure that enrollees' financial burdens are effectively reduced when they receive assistance for medications.

Contention

One notable point of contention surrounding SB523 may include how insurance companies will adapt their coverage policies to meet these new requirements, as this could influence their overall cost structures. Furthermore, there may be concerns regarding the financial implications for health plans and whether they will raise premium costs to offset the mandated changes. Stakeholders, including insurance providers and consumer advocacy groups, could have differing views on the efficacy and necessity of these regulations, affecting discussions on implementation.