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