Texas 2019 - 86th Regular

Texas House Bill HB698 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	86R26825 PMO-F
2		-	By: Blanco, Oliverson, Sheffield H.B. No. 698
3		-	Substitute the following for H.B. No. 698:
4		-	By: Lucio III C.S.H.B. No. 698
	1	+	86R564 BEE-F
	2	+	By: Blanco H.B. No. 698
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to certain protected practices of pharmacists and
10	8		pharmacies regarding amounts charged for prescription drugs.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Chapter 1369, Insurance Code, is amended by
13	11		adding Subchapter K to read as follows:
14	12		SUBCHAPTER K. PROTECTED PRACTICES REGARDING PRESCRIPTION DRUG
15	13		CHARGES
16	14		Sec. 1369.501. DEFINITIONS. In this subchapter:
17	15		(1) "Enrollee" means an individual who is covered
18	16		under a health benefit plan, including a covered dependent.
19	17		(2) "Prescription drug" has the meaning assigned by
20	18		Section 551.003, Occupations Code.
21	19		Sec. 1369.502. APPLICABILITY OF SUBCHAPTER. (a) This
22	20		subchapter applies only to a health benefit plan that provides
23	21		benefits for medical or surgical expenses incurred as a result of a
24	22		health condition, accident, or sickness, including an individual,
25	23		group, blanket, or franchise insurance policy or insurance
26	24		agreement, a group hospital service contract, or an individual or
27	25		group evidence of coverage or similar coverage document that is
28	26		issued by:
29	27		(1) an insurance company;
30	28		(2) a group hospital service corporation operating
31	29		under Chapter 842;
32	30		(3) a health maintenance organization operating under
33	31		Chapter 843;
34	32		(4) an approved nonprofit health corporation that
35	33		holds a certificate of authority under Chapter 844;
36	34		(5) a multiple employer welfare arrangement that holds
37	35		a certificate of authority under Chapter 846;
38	36		(6) a stipulated premium company operating under
39	37		Chapter 884;
40	38		(7) a fraternal benefit society operating under
41	39		Chapter 885;
42	40		(8) a Lloyd's plan operating under Chapter 941; or
43	41		(9) an exchange operating under Chapter 942.
44	42		(b) Notwithstanding any other law, this subchapter applies
45	43		to:
46	44		(1) a small employer health benefit plan subject to
47	45		Chapter 1501, including coverage provided through a health group
48	46		cooperative under Subchapter B of that chapter;
49	47		(2) a standard health benefit plan issued under
50	48		Chapter 1507;
51	49		(3) a basic coverage plan under Chapter 1551;
52	50		(4) a basic plan under Chapter 1575;
53	51		(5) a primary care coverage plan under Chapter 1579;
54	52		(6) a plan providing basic coverage under Chapter
55	53		1601;
56	54		(7) health benefits provided by or through a church
57	55		benefits board under Subchapter I, Chapter 22, Business
58	56		Organizations Code;
59	57		(8) group health coverage made available by a school
60	58		district in accordance with Section 22.004, Education Code;
61	59		(9) the state Medicaid program, including the Medicaid
62	60		managed care program operated under Chapter 533, Government Code;
63	61		(10) the child health plan program under Chapter 62,
64	62		Health and Safety Code;
65	63		(11) a regional or local health care program operated
66		-	under Section 75.104, Health and Safety Code; ~~and~~
	64	+	under Section 75.104, Health and Safety Code;
67	65		(12) a self-funded health benefit plan sponsored by a
68		-	professional employer organization under Chapter 91, Labor Code.
	66	+	professional employer organization under Chapter 91, Labor Code;
	67	+	(13) county employee group health benefits provided
	68	+	under Chapter 157, Local Government Code; and
	69	+	(14) health and accident coverage provided by a risk
	70	+	pool created under Chapter 172, Local Government Code.
69	71		(c) This subchapter applies to coverage under a group health
70	72		benefit plan provided to a resident of this state regardless of
71	73		whether the group policy, agreement, or contract is delivered,
72	74		issued for delivery, or renewed in this state.
73	75		Sec. 1369.503. PROTECTED PRACTICES BY PHARMACISTS AND
74	76		PHARMACIES. An issuer of a health benefit plan that covers
75	77		prescription drugs or a pharmacy benefit manager as defined by
76	78		Section 4151.151 may not, as a condition of a contract with a
77	79		pharmacist or pharmacy providing a prescription drug or in any
78	80		other manner, prohibit or otherwise restrict a pharmacist or
79	81		pharmacy from or penalize a pharmacist or pharmacy for:
80	82		(1) informing an enrollee that the amount the
81	83		pharmacist or pharmacy charges for a prescription drug is less than
82	84		the enrollee's copayment, deductible, or coinsurance for the drug
83	85		under the plan or otherwise providing information to the enrollee
84	86		regarding the cost of the drug; or
85	87		(2) selling a prescription drug covered by the plan
86	88		for an amount that is less than the enrollee's copayment,
87	89		deductible, or coinsurance for the drug under the plan.
88	90		SECTION 2. Subchapter K, Chapter 1369, Insurance Code, as
89	91		added by this Act, applies only to a health benefit plan that is
90	92		delivered, issued for delivery, or renewed on or after January 1,
91	93		2020. A plan delivered, issued for delivery, or renewed before
92	94		January 1, 2020, is governed by the law as it existed immediately
93	95		before the effective date of this Act, and that law is continued in
94	96		effect for that purpose.
95		-	SECTION 3. If before implementing any provision of this Act
96		-	a state agency determines that a waiver or authorization from a
97		-	federal agency is necessary for implementation of that provision,
98		-	the agency affected by the provision shall request the waiver or
99		-	authorization and may delay implementing that provision until the
100		-	waiver or authorization is granted.
101		-	SECTION 4. This Act takes effect September 1, 2019.
	97	+	SECTION 3. This Act takes effect September 1, 2019.