Texas 2009 - 81st Regular

Texas House Bill HB2293 Compare Versions

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1	1	81R7767 KCR-F
2	2	By: Gattis, Gonzalez Toureilles, et al. H.B. No. 2293
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the delivery of prescription drugs for certain state
8	8	health plans by mail order; providing an administrative penalty.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle H, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1560 to read as follows:
12	12	CHAPTER 1560. DELIVERY OF PRESCRIPTION DRUGS BY MAIL
13	13	Sec. 1560.001. DEFINITIONS. In this chapter:
14	14	(1) "Community retail pharmacy" means a pharmacy that
15	15	is licensed as a Class A pharmacy under Chapter 560, Occupations
16	16	Code.
17	17	(2) "Mail order pharmacy" means a pharmacy that is
18	18	licensed under Chapter 560, Occupations Code, and that primarily
19	19	delivers prescription drugs to an enrollee through the United
20	20	States Postal Service or a commercial delivery service.
21	21	(3) "Prescription drug formulary" means a list of
22	22	prescription drugs preferred for use and eligible for coverage
23	23	under a health benefit plan.
24	24	Sec. 1560.002. APPLICABILITY OF CHAPTER. This chapter
25	25	applies only to a health benefit plan that provides benefits for
26	26	medical or surgical expenses incurred as a result of a health
27	27	condition, accident, or sickness, including an individual, group,
28	28	blanket, or franchise insurance policy or insurance agreement, a
29	29	group hospital service contract, or an individual or group evidence
30	30	of coverage or similar coverage document that is offered or
31	31	administered by:
32	32	(1) the Teacher Retirement System of Texas under
33	33	Chapter 1575 or 1579; or
34	34	(2) the Employees Retirement System of Texas under
35	35	Chapter 1551.
36	36	Sec. 1560.003. MULTIPLE-MONTH SUPPLY OF PRESCRIPTION DRUG.
37	37	(a) In this section, "multiple-month supply" means a supply for 60
38	38	or more days.
39	39	(b) Notwithstanding any other law, an issuer of a health
40	40	benefit plan that provides pharmacy benefits to enrollees must
41	41	allow an enrollee to obtain from a community retail pharmacy a
42	42	multiple-month supply of any prescription drug under the same terms
43	43	and conditions applicable when the prescription drug is obtained
44	44	from a mail order pharmacy, if the community retail pharmacy agrees
45	45	to accept reimbursement on exactly the same terms and conditions
46	46	that apply to a mail order pharmacy.
47	47	(c) This section does not require:
48	48	(1) the issuer of a health benefit plan to contract
49	49	with:
50	50	(A) a retail pharmacy that does not agree to
51	51	accept reimbursement on exactly the same terms and conditions that
52	52	apply to a mail order pharmacy; or
53	53	(B) more than one mail order pharmacy; or
54	54	(2) a community retail pharmacy to:
55	55	(A) provide a multiple-month supply of a
56	56	prescription drug under the same terms and conditions applicable
57	57	when the prescription drug is obtained from a mail order pharmacy;
58	58	or
59	59	(B) agree to accept reimbursement on exactly the
60	60	same terms and conditions that apply to a mail order pharmacy.
61	61	Sec. 1560.004. PRESCRIPTION DRUG REIMBURSEMENT RATES. (a)
62	62	An issuer of a health benefit plan that provides pharmacy benefits
63	63	to enrollees shall reimburse pharmacies participating in the health
64	64	plan using prescription drug reimbursement rates, for both brand
65	65	name and generic prescription drugs, that are based on a current and
66	66	nationally recognized benchmark index that includes average
67	67	wholesale price and maximum allowable cost.
68	68	(b) Regardless of whether a pharmacy is a mail order
69	69	pharmacy or a community retail pharmacy, an issuer of a health
70	70	benefit plan shall use the same benchmark index, including the same
71	71	average wholesale price, maximum allowable cost, and national
72	72	prescription drug codes, to reimburse all pharmacies participating
73	73	in the health benefit plan.
74	74	Sec. 1560.005. ACQUISITION COSTS AND REBATES. An issuer of
75	75	a health benefit plan that contracts with a third-party
76	76	administrator, pharmacy benefit manager, or other entity to manage
77	77	pharmacy benefits provided to enrollees through a mail order
78	78	pharmacy shall require the managing entity to:
79	79	(1) provide the issuer of the health benefit plan with
80	80	an annual electronic report containing:
81	81	(A) the actual acquisition cost of all drugs
82	82	purchased by the managing entity in relation to the pharmacy
83	83	benefits under the health benefit plan; and
84	84	(B) an identification of the source, type, and
85	85	amount of all rebates, rebate administrative fees, and other
86	86	monetary benefits received by the managing entity from a drug
87	87	manufacturer in relation to the pharmacy benefits under the health
88	88	benefit plan; and
89	89	(2) not later than the 30th day after the date the
90	90	managing entity receives a rebate, rebate administrative fee, or
91	91	other monetary benefit from a drug manufacturer in relation to the
92	92	pharmacy benefits under the health benefit plan, reimburse or
93	93	credit to the issuer of the health benefit plan an amount equal to
94	94	the amount of the rebate, rebate administrative fee, or other
95	95	monetary benefit received by the managing entity.
96	96	Sec. 1560.006. PHARMACY BENEFIT MANAGERS: DESIGNATION OF
97	97	CONFIDENTIAL INFORMATION. (a) A pharmacy benefit manager may
98	98	designate as confidential any information the pharmacy benefit
99	99	manager is required to disclose under Section 1560.005.
100	100	(b) Information designated as confidential under this
101	101	section may not be disclosed to any person without the consent of
102	102	the pharmacy benefit manager unless the disclosure is:
103	103	(1) ordered by a court for good cause shown;
104	104	(2) made under seal in a court filing; or
105	105	(3) made to the commissioner of insurance or the
106	106	attorney general in connection with an investigation authorized by
107	107	this code, the Government Code, or any other law.
108	108	Sec. 1560.007. COMPLAINT AND ENFORCEMENT; ADMINISTRATIVE
109	109	PENALTIES. (a) The department shall investigate any complaint
110	110	that the department receives concerning conduct regulated by this
111	111	chapter.
112	112	(b) Following an investigation under Subsection (a), the
113	113	commissioner shall issue a written determination of the outcome of
114	114	the investigation, including whether the department has taken or
115	115	intends to take any action under Chapters 81-86.
116	116	(c) If, as a result of a complaint investigated under
117	117	Subsection (a), the commissioner determines that an issuer of a
118	118	health benefit plan has violated this chapter, the commissioner
119	119	shall impose an administrative penalty against the issuer of the
120	120	health benefit plan in accordance with Chapter 84. The amount of an
121	121	administrative penalty imposed under this subsection may not exceed
122	122	$1,000 per prescription that was filled or that was not filled in
123	123	violation of this chapter. The limitation on the amount of an
124	124	administrative penalty under Section 84.022 does not apply to an
125	125	administrative penalty imposed under this subsection.
126	126	SECTION 2. Section 1551.224, Insurance Code, is amended to
127	127	read as follows:
128	128	Sec. 1551.224. MAIL ORDER REQUIREMENT FOR PRESCRIPTION DRUG
129	129	COVERAGE PROHIBITED. (a) The board of trustees or a health benefit
130	130	plan under this chapter that provides benefits for prescription
131	131	drugs may not require a participant in the group benefits program to
132	132	purchase a prescription drug through a mail order program.
133	133	(b) Except as provided by Subsection (c), the [The] board of
134	134	trustees or a health benefit plan shall require that a participant
135	135	who chooses to obtain a prescription drug through a retail pharmacy
136	136	or other method other than by mail order pay a deductible,
137	137	copayment, coinsurance, or other cost-sharing obligation to cover
138	138	the additional cost of obtaining a prescription drug through that
139	139	method rather than by mail order.
140	140	(c) The board of trustees or a health benefit plan may not
141	141	require a participant who obtains a multiple-month supply of a
142	142	prescription drug from a retail pharmacy under Section 1560.003 to
143	143	pay a deductible, copayment, coinsurance, or other cost-sharing
144	144	obligation that differs from the amount the participant pays for a
145	145	multiple-month supply of that drug through a mail order program.
146	146	SECTION 3. The change in law made by this Act applies only
147	147	to a health benefit plan that is delivered, issued for delivery, or
148	148	renewed on or after January 1, 2010. A health benefit plan that is
149	149	delivered, issued for delivery, or renewed before January 1, 2010,
150	150	is covered by the law in effect at the time the policy was
151	151	delivered, issued for delivery, or renewed, and that law is
152	152	continued in effect for that purpose.
153	153	SECTION 4. This Act takes effect September 1, 2009.