Texas 2017 - 85th Regular

Texas Senate Bill SB895 Compare Versions

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

Old	New	Differences
1	1	85R5843 PMO-D
2	2	By: Seliger S.B. No. 895
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the transparency of certain information related to
8	8	prescription drug coverage provided by certain health benefit
9	9	plans.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 1369, Insurance Code, is amended by
12	12	adding Subchapter B-1 to read as follows:
13	13	SUBCHAPTER B-1. TRANSPARENCY REQUIREMENTS FOR CERTAIN INDIVIDUAL
14	14	HEALTH BENEFIT PLANS
15	15	Sec. 1369.076. DEFINITIONS. In this subchapter, terms
16	16	defined by Subchapter B have the meanings assigned by that
17	17	subchapter.
18	18	Sec. 1369.077. APPLICABILITY OF SUBCHAPTER. This
19	19	subchapter applies only to a health benefit plan that:
20	20	(1) provides prescription drug coverage under an
21	21	individual health benefit plan to which Subchapter B applies; and
22	22	(2) uses one or more drug formularies to specify the
23	23	prescription drugs covered under the plan.
24	24	SECTION 2. Sections 1369.0542 through 1369.0544, Insurance
25	25	Code, are transferred to Subchapter B-1, Insurance Code,
26	26	redesignated as Sections 1369.078 through 1369.080, and amended to
27	27	read as follows:
28	28	Sec. 1369.078 [1369.0542]. FORMULARY INFORMATION ON
29	29	INTERNET WEBSITE. (a) A health benefit plan issuer shall display
30	30	on a public Internet website maintained by the issuer formulary
31	31	information for each of the issuer's individual health benefit
32	32	plans as required by the commissioner by rule.
33	33	(b) A direct electronic link to the formulary information
34	34	must be displayed in a conspicuous manner in the electronic summary
35	35	of benefits and coverage of each individual health benefit plan
36	36	issued by the health benefit plan issuer on the health benefit plan
37	37	issuer's Internet website. The information must be publicly
38	38	accessible to enrollees, prospective enrollees, and others without
39	39	necessity of providing a password, a user name, or personally
40	40	identifiable information.
41	41	Sec. 1369.079 [1369.0543]. FORMULARY DISCLOSURE
42	42	REQUIREMENTS. (a) The commissioner shall develop and adopt by rule
43	43	requirements to promote consistency and clarity in the disclosure
44	44	of formularies to facilitate comparison shopping among individual
45	45	health benefit plans.
46	46	(b) The requirements adopted under Subsection (a) must
47	47	apply to each prescription drug:
48	48	(1) included in a formulary and dispensed in a network
49	49	pharmacy; or
50	50	(2) covered under an individual [a] health benefit
51	51	plan and typically administered by a physician or health care
52	52	provider.
53	53	(c) The formulary disclosures must:
54	54	(1) be electronically searchable by drug name;
55	55	(2) include for each drug the information required by
56	56	Subsection (d) in the order listed in that subsection; and
57	57	(3) indicate each formulary that applies to each
58	58	individual health benefit plan issued by the issuer.
59	59	(d) The formulary disclosures must include for each drug:
60	60	(1) the cost-sharing amount for each drug, including
61	61	as applicable:
62	62	(A) the dollar amount of a copayment; or
63	63	(B) for a drug subject to coinsurance:
64	64	(i) an enrollee's cost-sharing amount
65	65	stated in dollars; or
66	66	(ii) a cost-sharing range, denoted as
67	67	follows:
68	68	(a) under $100 - $;
69	69	(b) $100-$250 - $$;
70	70	(c) $251-$500 - $$$;
71	71	(d) $501-$1,000 - $$$$; or
72	72	(e) over $1,000 - $$$$$;
73	73	(2) a disclosure of prior authorization, step therapy,
74	74	or other protocol requirements for each drug;
75	75	(3) if the individual health benefit plan uses a
76	76	tier-based formulary, the specific tier for each drug listed in the
77	77	formulary;
78	78	(4) a description of how prescription drugs will
79	79	specifically be included in or excluded from the deductible,
80	80	including a description of out-of-pocket costs for a prescription
81	81	drug that may not apply to the deductible;
82	82	(5) identification of preferred formulary drugs; and
83	83	(6) an explanation of coverage of each formulary drug.
84	84	(e) The commissioner by rule may allow an alternative method
85	85	of making disclosures required under Subsection (d)(1) relating to
86	86	cost-sharing through a web-based tool that must:
87	87	(1) be publicly accessible to enrollees, prospective
88	88	enrollees, and others without necessity of providing a password, a
89	89	user name, or personally identifiable information;
90	90	(2) allow consumers to electronically search
91	91	formulary information by the name under which the individual health
92	92	benefit plan is marketed; and
93	93	(3) be accessible through a direct link that is
94	94	displayed on each page of the formulary disclosure that lists each
95	95	drug as required under Subsection (c).
96	96	Sec. 1369.080 [1369.0544]. FORMULARY INFORMATION PROVIDED
97	97	BY TOLL-FREE TELEPHONE NUMBER. In addition to providing the
98	98	information described by Section 1369.079(d)(1) in the manner
99	99	required by Section 1369.079 [1369.0543(d)(1)], a health benefit
100	100	plan issuer may make the information available to enrollees,
101	101	prospective enrollees, and others through a toll-free telephone
102	102	number that operates at least during normal business hours.
103	103	SECTION 3. The changes in law made by this Act apply only to
104	104	a health benefit plan that is delivered, issued for delivery, or
105	105	renewed on or after September 1, 2017. A health benefit plan
106	106	delivered, issued for delivery, or renewed before September 1,
107	107	2017, is governed by the law as it existed immediately before the
108	108	effective date of this Act, and that law is continued in effect for
109	109	that purpose.
110	110	SECTION 4. This Act takes effect September 1, 2017.