| 1 | 1 | | 85R6501 SMT-D |
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| 2 | 2 | | By: Buckingham S.B. No. 1040 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to health benefit plan coverage for accelerated refills of |
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| 8 | 8 | | certain prescription eye drops. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter A, Chapter 1369, Insurance Code, is |
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| 11 | 11 | | amended by adding Section 1369.0041 to read as follows: |
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| 12 | 12 | | Sec. 1369.0041. ACCELERATED REFILLS OF CERTAIN |
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| 13 | 13 | | PRESCRIPTION EYE DROPS. (a) Subject to Subsection (b), a health |
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| 14 | 14 | | benefit plan that covers prescription eye drops to treat a chronic |
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| 15 | 15 | | eye disease or condition may not deny coverage for a refill of the |
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| 16 | 16 | | eye drops because the prescription is being refilled before the |
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| 17 | 17 | | date established by the plan's general prescription refill |
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| 18 | 18 | | guidelines if: |
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| 19 | 19 | | (1) the original prescription states that additional |
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| 20 | 20 | | quantities of the eye drops are needed; and |
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| 21 | 21 | | (2) the refill does not exceed the total quantity of |
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| 22 | 22 | | dosage units authorized by the prescribing provider on the original |
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| 23 | 23 | | prescription, including refills. |
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| 24 | 24 | | (b) A health benefit plan must provide coverage for the |
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| 25 | 25 | | refill of a prescription for eye drops described by Subsection (a) |
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| 26 | 26 | | that is dispensed on or before the last day of the prescribed dosage |
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| 27 | 27 | | period and: |
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| 28 | 28 | | (1) not earlier than the 21st day after the date a |
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| 29 | 29 | | prescription for a 30-day supply of eye drops is dispensed; |
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| 30 | 30 | | (2) not earlier than the 42nd day after the date a |
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| 31 | 31 | | prescription for a 60-day supply of eye drops is dispensed; or |
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| 32 | 32 | | (3) not earlier than the 63rd day after the date a |
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| 33 | 33 | | prescription for a 90-day supply of eye drops is dispensed. |
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| 34 | 34 | | (c) A health benefit plan may not impose a deductible, |
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| 35 | 35 | | copayment, coinsurance, or other cost-sharing provision applicable |
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| 36 | 36 | | to benefits for an accelerated refill under this section unless the |
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| 37 | 37 | | amount of the required cost-sharing is the same as or less than the |
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| 38 | 38 | | amount of the required cost-sharing applicable to benefits for |
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| 39 | 39 | | other prescription drugs under the plan. |
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| 40 | 40 | | SECTION 2. Section 1369.0041, Insurance Code, as added by |
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| 41 | 41 | | this Act, applies only to a health benefit plan delivered, issued |
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| 42 | 42 | | for delivery, or renewed on or after January 1, 2018. A health |
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| 43 | 43 | | benefit plan delivered, issued for delivery, or renewed before |
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| 44 | 44 | | January 1, 2018, is governed by the law as it existed immediately |
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| 45 | 45 | | before the effective date of this Act, and that law is continued in |
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| 46 | 46 | | effect for that purpose. |
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| 47 | 47 | | SECTION 3. This Act takes effect September 1, 2017. |
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