Texas 2013 - 83rd Regular

Texas House Bill HB3455 Compare Versions

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1	1	83R3747 PMO-F
2	2	By: Eiland H.B. No. 3455
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to access to pharmaceutical care under certain health
8	8	benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1451, Insurance Code, is amended by
11	11	adding Subchapter J to read as follows:
12	12	SUBCHAPTER J. ACCESS TO PHARMACEUTICAL CARE
13	13	Sec. 1451.451. DEFINITIONS. In this subchapter:
14	14	(1) "Drug" has the meaning assigned by Section
15	15	551.003, Occupations Code.
16	16	(2) "Enrollee" means an individual who is covered
17	17	under a health benefit plan, including a covered dependent.
18	18	(3) "Pharmaceutical care" has the meaning assigned by
19	19	Section 551.003, Occupations Code.
20	20	(4) "Pharmacist" has the meaning assigned by Section
21	21	551.003, Occupations Code.
22	22	(5) "Pharmacy" has the meaning assigned by Section
23	23	551.003, Occupations Code.
24	24	Sec. 1451.452. APPLICABILITY OF SUBCHAPTER. (a) This
25	25	subchapter applies only to a health benefit plan that provides
26	26	benefits for drugs or pharmaceutical care expenses incurred as a
27	27	result of a health condition, accident, or sickness, including an
28	28	individual, group, blanket, or franchise insurance policy or
29	29	insurance agreement, a group hospital service contract, or an
30	30	individual or group evidence of coverage or similar coverage
31	31	document that is offered by:
32	32	(1) an insurance company;
33	33	(2) a group hospital service corporation operating
34	34	under Chapter 842;
35	35	(3) a fraternal benefit society operating under
36	36	Chapter 885;
37	37	(4) a stipulated premium company operating under
38	38	Chapter 884;
39	39	(5) an exchange operating under Chapter 942;
40	40	(6) a health maintenance organization operating under
41	41	Chapter 843;
42	42	(7) a multiple employer welfare arrangement that holds
43	43	a certificate of authority under Chapter 846; or
44	44	(8) an approved nonprofit health corporation that
45	45	holds a certificate of authority under Chapter 844.
46	46	(b) This subchapter does not apply to:
47	47	(1) a plan that provides coverage:
48	48	(A) for wages or payments in lieu of wages for a
49	49	period during which an employee is absent from work because of
50	50	sickness or injury;
51	51	(B) as a supplement to a liability insurance
52	52	policy;
53	53	(C) for credit insurance;
54	54	(D) only for dental or vision care;
55	55	(E) only for hospital expenses; or
56	56	(F) only for indemnity for hospital confinement;
57	57	(2) a Medicare supplemental policy as defined by
58	58	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
59	59	1395ss(g)(1));
60	60	(3) a workers' compensation insurance policy;
61	61	(4) medical payment insurance coverage provided under
62	62	a motor vehicle insurance policy; or
63	63	(5) a long-term care policy, including a nursing home
64	64	fixed indemnity policy, unless the commissioner determines that the
65	65	policy provides benefit coverage so comprehensive that the policy
66	66	is a health benefit plan as described by Subsection (a).
67	67	Sec. 1451.453. PROHIBITED CONTRACTUAL PROVISIONS. (a) A
68	68	health benefit plan may not:
69	69	(1) prohibit or limit an enrollee from selecting a
70	70	pharmacy or pharmacist of the enrollee's choice to be a provider to
71	71	furnish pharmaceutical care covered by the plan;
72	72	(2) deny a pharmacy or pharmacist the right to
73	73	participate as a provider under the plan if the pharmacy or
74	74	pharmacist agrees to provide pharmaceutical care consistent with
75	75	the terms of the plan and to accept the administrative, financial,
76	76	and professional conditions that apply uniformly to pharmacies and
77	77	pharmacists designated as providers under the plan; or
78	78	(3) require an enrollee to obtain or request a
79	79	specific quantity or dosage supply of pharmaceutical products.
80	80	(b) Notwithstanding Subsection (a)(3), a health benefit
81	81	plan may allow a physician of an enrollee to prescribe drugs in a
82	82	quantity or dosage supply the physician determines appropriate and
83	83	that is in compliance with state and federal statutes.
84	84	(c) This section does not prohibit a health benefit plan
85	85	from:
86	86	(1) in an effort to achieve cost savings to the plan
87	87	and the enrollee, provided that the limitations or incentives are
88	88	applied uniformly to all designated providers of pharmaceutical
89	89	care under the plan:
90	90	(A) limiting the quantity or dosage supply of
91	91	drugs covered under the plan; or
92	92	(B) providing financial incentives to
93	93	prescribing physicians or enrollees to encourage use of certain
94	94	drugs or pharmaceutical care in certain quantities;
95	95	(2) implementing or administering a pharmacy benefit
96	96	card program that authorizes an enrollee to obtain drugs or
97	97	pharmaceutical care through designated providers; or
98	98	(3) establishing uniform and reasonable application
99	99	and renewal fees for pharmacies or pharmacists that provide
100	100	pharmaceutical care as a provider under the plan.
101	101	Sec. 1451.454. COVERAGE NOT REQUIRED. This subchapter does
102	102	not require a health benefit plan to provide coverage for drugs or
103	103	pharmaceutical care.
104	104	Sec. 1451.455. DEPARTMENT MONITORING. The commissioner
105	105	shall monitor health benefit plans to ensure compliance with this
106	106	subchapter.
107	107	Sec. 1451.456. RULEMAKING. The commissioner may adopt
108	108	rules as necessary to implement this subchapter.
109	109	SECTION 2. Article 21.52B, Insurance Code, is repealed.
110	110	SECTION 3. This Act applies only to a health benefit plan
111	111	that is delivered, issued for delivery, or renewed on or after
112	112	January 1, 2014. A health benefit plan delivered, issued for
113	113	delivery, or renewed before January 1, 2014, is governed by the law
114	114	as it existed immediately before the effective date of this Act, and
115	115	that law is continued in effect for that purpose.
116	116	SECTION 4. This Act takes effect September 1, 2013.