Texas 2017 - 85th Regular

Texas House Bill HB1296 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Frullo, et al. (Senate Sponsor - Buckingham) H.B. No. 1296
2		-	(In the Senate - Received from the House May 3, 2017;
3		-	May 16, 2017, read first time and referred to Committee on Business &
4		-	Commerce; May 21, 2017, reported favorably by the following vote:
5		-	Yeas 8, Nays 0; May 21, 2017, sent to printer.)
6		-	Click here to see the committee vote
	1	+	H.B. No. 1296
7	2
8	3
9		-	A BILL TO BE ENTITLED
10	4		AN ACT
11	5		relating to health benefit coverage for prescription drug
12	6		synchronization.
13	7		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	8		SECTION 1. Chapter 1369, Insurance Code, is amended by
15	9		adding Subchapter J to read as follows:
16	10		SUBCHAPTER J. COVERAGE RELATED TO PRESCRIPTION DRUG
17	11		SYNCHRONIZATION
18	12		Sec. 1369.451. DEFINITIONS. In this subchapter:
19	13		(1) "Cost-sharing amount" includes an amount charged
20	14		for a deductible, coinsurance, or copayment.
21	15		(2) "Health care provider" means a person who provides
22	16		health care services under a license, certificate, registration, or
23	17		other similar evidence of regulation issued by this or another
24	18		state of the United States.
25	19		(3) "Physician" means an individual licensed to
26	20		practice medicine in this or another state of the United States.
27	21		Sec. 1369.452. APPLICABILITY OF SUBCHAPTER. (a) This
28	22		subchapter applies only to a health benefit plan that provides
29	23		benefits for medical or surgical expenses incurred as a result of a
30	24		health condition, accident, or sickness, including an individual,
31	25		group, blanket, or franchise insurance policy or insurance
32	26		agreement, a group hospital service contract, or an individual or
33	27		group evidence of coverage or similar coverage document that is
34	28		offered by:
35	29		(1) an insurance company;
36	30		(2) a group hospital service corporation operating
37	31		under Chapter 842;
38	32		(3) a health maintenance organization operating under
39	33		Chapter 843;
40	34		(4) an approved nonprofit health corporation that
41	35		holds a certificate of authority under Chapter 844;
42	36		(5) a multiple employer welfare arrangement that holds
43	37		a certificate of authority under Chapter 846;
44	38		(6) a stipulated premium company operating under
45	39		Chapter 884;
46	40		(7) a fraternal benefit society operating under
47	41		Chapter 885; or
48	42		(8) an exchange operating under Chapter 942.
49	43		(b) This subchapter applies to group health coverage made
50	44		available by a school district in accordance with Section 22.004,
51	45		Education Code.
52	46		(c) Notwithstanding any provision in Chapter 1551, 1575,
53	47		1579, or 1601 or any other law, this subchapter applies to health
54	48		benefit plan coverage provided under:
55	49		(1) Chapter 1551;
56	50		(2) Chapter 1575;
57	51		(3) Chapter 1579; and
58	52		(4) Chapter 1601.
59	53		(d) Notwithstanding Section 1501.251 or any other law, this
60	54		subchapter applies to coverage under a small employer health
61	55		benefit plan subject to Chapter 1501.
62	56		(e) This subchapter applies to a standard health benefit
63	57		plan issued under Chapter 1507.
64	58		(f) To the extent allowed by federal law, the child health
65	59		plan program operated under Chapter 62, Health and Safety Code, and
66	60		the state Medicaid program, including the Medicaid managed care
67	61		program operated under Chapter 533, Government Code, shall provide
68	62		the coverage required under this subchapter to a recipient.
69	63		Sec. 1369.453. APPLICABILITY TO CERTAIN MEDICATIONS. This
70	64		subchapter applies with respect to only a medication that:
71	65		(1) is covered by the enrollee's health benefit plan;
72	66		(2) meets the prior authorization criteria
73	67		specifically applicable to the medication under the health benefit
74	68		plan on the date the request for synchronization is made;
75	69		(3) is used for treatment and management of a chronic
76	70		illness, as that term is defined by Section 1369.456;
77	71		(4) may be prescribed with refills;
78	72		(5) is a formulation that can be effectively dispensed
79	73		in accordance with the medication synchronization plan described by
80	74		Section 1369.456; and
81	75		(6) is not, according to the schedules established by
82	76		the commissioner of the Department of State Health Services under
83	77		Chapter 481, Health and Safety Code:
84	78		(A) a Schedule II controlled substance; or
85	79		(B) a Schedule III controlled substance
86	80		containing hydrocodone.
87	81		Sec. 1369.454. PRORATION OF COST-SHARING AMOUNT REQUIRED.
88	82		(a) A health benefit plan that provides benefits for prescription
89	83		drugs shall prorate any cost-sharing amount charged for a partial
90	84		supply of a prescription drug if:
91	85		(1) the pharmacy or the enrollee's prescribing
92	86		physician or health care provider notifies the health benefit plan
93	87		that:
94	88		(A) the quantity dispensed is to synchronize the
95	89		dates that the pharmacy dispenses the enrollee's prescription
96	90		drugs; and
97	91		(B) the synchronization of the dates is in the
98	92		best interest of the enrollee; and
99	93		(2) the enrollee agrees to the synchronization.
100	94		(b) The proration described by Subsection (a) must be based
101	95		on the number of days' supply of the drug actually dispensed.
102	96		Sec. 1369.455. PRORATION OF DISPENSING FEE PROHIBITED. A
103	97		health benefit plan that prorates a cost-sharing amount as required
104	98		by Section 1369.454 may not prorate the fee paid to the pharmacy for
105	99		dispensing the drug for which the cost-sharing amount was prorated.
106	100		Sec. 1369.456. IMPLEMENTATION OF CERTAIN MEDICATION
107	101		SYNCHRONIZATION PLANS. (a) For the purposes of this section:
108	102		(1) "Chronic illness" means an illness or physical
109	103		condition that may be:
110	104		(A) reasonably expected to continue for an
111	105		uninterrupted period of at least three months; and
112	106		(B) controlled but not cured by medical
113	107		treatment.
114	108		(2) "Medication synchronization plan" means a plan
115	109		established for the purpose of synchronizing the filling or
116	110		refilling of multiple prescriptions.
117	111		(b) A health benefit plan shall establish a process through
118	112		which the following parties may jointly approve a medication
119	113		synchronization plan for medication to treat an enrollee's chronic
120	114		illness:
121	115		(1) the health benefit plan;
122	116		(2) the enrollee;
123	117		(3) the prescribing physician or health care provider;
124	118		and
125	119		(4) a pharmacist.
126	120		(c) A health benefit plan shall provide coverage for a
127	121		medication dispensed in accordance with the dates established in
128	122		the medication synchronization plan described by Subsection (b).
129	123		(d) A health benefit plan shall establish a process that
130	124		allows a pharmacist or pharmacy to override the health benefit
131	125		plan's denial of coverage for a medication described by Subsection
132	126		(b).
133	127		(e) A health benefit plan shall allow a pharmacist or
134	128		pharmacy to override the health benefit plan's denial of coverage
135	129		through the process described by Subsection (d), and the health
136	130		benefit plan shall provide coverage for the medication if:
137	131		(1) the prescription for the medication is being
138	132		refilled in accordance with the medication synchronization plan
139	133		described by Subsection (b); and
140	134		(2) the reason for the denial is that the prescription
141	135		is being refilled before the date established by the plan's general
142	136		prescription refill guidelines.
143	137		SECTION 2. This Act applies only to a health benefit plan
144	138		that is delivered, issued for delivery, or renewed on or after
145	139		January 1, 2018. A health benefit plan delivered, issued for
146	140		delivery, or renewed before January 1, 2018, is governed by the law
147	141		as it existed immediately before the effective date of this Act, and
148	142		that law is continued in effect for that purpose.
149	143		SECTION 3. This Act takes effect September 1, 2017.
150		-	* * * * *
	144	+	______________________________ ______________________________
	145	+	President of the Senate Speaker of the House
	146	+	I certify that H.B. No. 1296 was passed by the House on May 3,
	147	+	2017, by the following vote: Yeas 135, Nays 12, 1 present, not
	148	+	voting.
	149	+	______________________________
	150	+	Chief Clerk of the House
	151	+	I certify that H.B. No. 1296 was passed by the Senate on May
	152	+	23, 2017, by the following vote: Yeas 29, Nays 2.
	153	+	______________________________
	154	+	Secretary of the Senate
	155	+	APPROVED: _____________________
	156	+	Date
	157	+	_____________________
	158	+	Governor