Texas 2017 - 85th Regular

Texas House Bill HB2882 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R2884 SMT-F
2	2	By: Oliverson H.B. No. 2882
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to modification of certain prescription drug benefits and
8	8	coverage offered by certain health benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1369.0541, Insurance Code, is amended by
11	11	amending Subsections (a) and (b) and adding Subsection (b-1) to
12	12	read as follows:
13	13	(a) Except as provided by Section 1369.055(a-1) and
14	14	Subsection (b-1) of this section, a [A] health benefit plan issuer
15	15	may modify drug coverage provided under a health benefit plan if:
16	16	(1) the modification occurs at the time of coverage
17	17	renewal;
18	18	(2) the modification is effective uniformly among all
19	19	group health benefit plan sponsors covered by identical or
20	20	substantially identical health benefit plans or all individuals
21	21	covered by identical or substantially identical individual health
22	22	benefit plans, as applicable; and
23	23	(3) not later than the 60th day before the date the
24	24	modification is effective, the issuer provides written notice of
25	25	the modification to the commissioner, each affected group health
26	26	benefit plan sponsor, each affected enrollee in an affected group
27	27	health benefit plan, and each affected individual health benefit
28	28	plan holder.
29	29	(b) Modifications affecting drug coverage that require
30	30	notice under Subsection (a) include:
31	31	(1) removing a drug from a formulary;
32	32	(2) adding a requirement that an enrollee receive
33	33	prior authorization for a drug;
34	34	(3) imposing or altering a quantity limit for a drug;
35	35	(4) imposing a step-therapy restriction for a drug;
36	36	[and]
37	37	(5) moving a drug to a higher cost-sharing tier;
38	38	(6) increasing a coinsurance, copayment, deductible,
39	39	or other out-of-pocket expense that an enrollee must pay for a drug;
40	40	and
41	41	(7) reducing the maximum drug coverage amount [unless
42	42	a generic drug alternative to the drug is available].
43	43	(b-1) Modifications affecting drug coverage that are more
44	44	favorable to enrollees may be made at any time and do not require
45	45	notice under Subsection (a), including:
46	46	(1) the addition of a drug to a formulary;
47	47	(2) the reduction of a coinsurance, copayment,
48	48	deductible, or other out-of-pocket expense that an enrollee must
49	49	pay for a drug; and
50	50	(3) the removal of a utilization review requirement.
51	51	SECTION 2. Section 1369.055, Insurance Code, is amended by
52	52	adding Subsections (a-1) and (a-2) to read as follows:
53	53	(a-1) On renewal of a health benefit plan, the plan issuer
54	54	may not modify an enrollee's contracted benefit level for any
55	55	prescription drug that was approved or covered under the plan in the
56	56	immediately preceding plan year and prescribed during that year for
57	57	a medical condition or mental illness of the enrollee if:
58	58	(1) the enrollee was covered by the health benefit
59	59	plan on the date immediately preceding the renewal date;
60	60	(2) a physician or other prescribing provider
61	61	appropriately prescribes the drug for the medical condition or
62	62	mental illness;
63	63	(3) the prescribing provider in consultation with the
64	64	enrollee determines that the drug is the most appropriate course of
65	65	treatment; and
66	66	(4) the drug is considered safe and effective for
67	67	treating the enrollee's medical condition or mental illness.
68	68	(a-2) Modifications prohibited under Subsection (a-1)
69	69	include:
70	70	(1) removing a drug from a formulary;
71	71	(2) adding a requirement that an enrollee receive
72	72	prior authorization for a drug;
73	73	(3) imposing or altering a quantity limit for a drug;
74	74	(4) imposing a step-therapy restriction for a drug;
75	75	and
76	76	(5) moving a drug to a higher cost-sharing tier.
77	77	SECTION 3. The changes in law made by this Act apply only to
78	78	a health benefit plan that is delivered, issued for delivery, or
79	79	renewed on or after January 1, 2018. A health benefit plan
80	80	delivered, issued for delivery, or renewed before January 1, 2018,
81	81	is governed by the law as it existed immediately before the
82	82	effective date of this Act, and that law is continued in effect for
83	83	that purpose.
84	84	SECTION 4. This Act takes effect September 1, 2017.