Texas 2021 - 87th Regular

Texas House Bill HB1701 Compare Versions

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

Old	New	Differences
1	1	87R5962 SMT-D
2	2	By: Price H.B. No. 1701
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to pricing of and health benefit plan cost-sharing
8	8	requirements for prescription insulin.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1358.054(b), Insurance Code, is amended
11	11	to read as follows:
12	12	(b) Except as provided by Section 1358.103(c), a [A] health
13	13	benefit plan may require a deductible, copayment, or coinsurance
14	14	for coverage provided under this section. The amount of the
15	15	deductible, copayment, or coinsurance may not exceed the amount of
16	16	the deductible, copayment, or coinsurance required for treatment of
17	17	other analogous chronic medical conditions.
18	18	SECTION 2. Chapter 1358, Insurance Code, is amended by
19	19	adding Subchapter C to read as follows:
20	20	SUBCHAPTER C. COST-SHARING LIMIT
21	21	Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This
22	22	subchapter applies only to a health benefit plan that provides
23	23	benefits for medical or surgical expenses incurred as a result of a
24	24	health condition, accident, or sickness, including an individual,
25	25	group, blanket, or franchise insurance policy or insurance
26	26	agreement, a group hospital service contract, or a small or large
27	27	employer group contract or similar coverage document that is
28	28	offered by:
29	29	(1) an insurance company;
30	30	(2) a group hospital service corporation operating
31	31	under Chapter 842;
32	32	(3) a fraternal benefit society operating under
33	33	Chapter 885;
34	34	(4) a stipulated premium company operating under
35	35	Chapter 884;
36	36	(5) a reciprocal exchange operating under Chapter 942;
37	37	(6) a health maintenance organization operating under
38	38	Chapter 843;
39	39	(7) a multiple employer welfare arrangement that holds
40	40	a certificate of authority under Chapter 846; or
41	41	(8) an approved nonprofit health corporation that
42	42	holds a certificate of authority under Chapter 844.
43	43	(b) This subchapter applies to group health coverage made
44	44	available by a school district in accordance with Section 22.004,
45	45	Education Code.
46	46	(c) Notwithstanding any provision in Chapter 1551, 1575,
47	47	1579, or 1601 or any other law, this subchapter applies to:
48	48	(1) a basic coverage plan under Chapter 1551;
49	49	(2) a basic plan under Chapter 1575;
50	50	(3) a primary care coverage plan under Chapter 1579;
51	51	and
52	52	(4) basic coverage under Chapter 1601.
53	53	Sec. 1358.102. EXCEPTION. This subchapter does not apply
54	54	to:
55	55	(1) a health benefit plan that provides coverage:
56	56	(A) only for a specified disease or for another
57	57	single benefit;
58	58	(B) only for accidental death or dismemberment;
59	59	(C) for wages or payments in lieu of wages for a
60	60	period during which an employee is absent from work because of
61	61	sickness or injury;
62	62	(D) as a supplement to a liability insurance
63	63	policy;
64	64	(E) for credit insurance;
65	65	(F) only for dental or vision care;
66	66	(G) only for hospital expenses; or
67	67	(H) only for indemnity for hospital confinement;
68	68	(2) a Medicare supplemental policy as defined by
69	69	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
70	70	(3) medical payment insurance coverage provided under
71	71	a motor vehicle insurance policy;
72	72	(4) a long-term care insurance policy, including a
73	73	nursing home fixed indemnity policy, unless the commissioner
74	74	determines that the policy provides benefit coverage so
75	75	comprehensive that the policy is a health benefit plan as described
76	76	by Section 1358.101;
77	77	(5) health and accident coverage provided by a risk
78	78	pool created under Chapter 172, Local Government Code; or
79	79	(6) a workers' compensation insurance policy.
80	80	Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In
81	81	this section, "insulin" means a prescription drug that contains
82	82	insulin, is used to treat diabetes, and is prescribed as medically
83	83	necessary by a physician.
84	84	(b) A health benefit plan that provides coverage for insulin
85	85	may not impose a cost-sharing provision for insulin if the total
86	86	amount the enrollee is required to pay exceeds $30 for a 30-day
87	87	supply, regardless of the amounts, types, or brands of insulin
88	88	needed to treat the enrollee's diabetes.
89	89	(c) A health benefit plan that provides coverage for insulin
90	90	may not impose a deductible applicable to insulin.
91	91	SECTION 3. (a) In this section, "commission" means the
92	92	Health and Human Services Commission.
93	93	(b) The commission shall conduct a study evaluating pricing
94	94	of prescription insulin drugs to ensure adequate consumer
95	95	protections in pricing of prescription insulin drugs and consider
96	96	whether additional consumer protections are necessary.
97	97	(c) The commission shall request from health benefit plan
98	98	issuers and prescription drug manufacturers information concerning
99	99	the organization, business practices, pricing information, data,
100	100	reports, or other information the commission determines is
101	101	necessary to conduct the study. The commission shall also consider
102	102	any publicly available information related to prescription insulin
103	103	pricing.
104	104	(d) A health benefit plan issuer or prescription drug
105	105	manufacturer who receives a request from the commission under
106	106	Subsection (c) of this section shall furnish the commission with
107	107	the information as soon as practicable after the date the issuer or
108	108	manufacturer receives the request.
109	109	(e) The commission may not require a health benefit plan
110	110	issuer or prescription drug manufacturer to disclose trade secrets
111	111	in information provided to the commission under Subsection (d) of
112	112	this section.
113	113	(f) Not later than September 1, 2022, the commission shall
114	114	prepare and submit to the governor, the lieutenant governor, and
115	115	the speaker of the house of representatives a written report
116	116	containing the results of the study. The report must include:
117	117	(1) a summary of insulin pricing practices and
118	118	variables that contribute to pricing of health benefit plans;
119	119	(2) policy recommendations to control and prevent
120	120	overpricing of prescription insulin; and
121	121	(3) any other information the commission determines is
122	122	necessary.
123	123	(g) The commission shall publish the report described by
124	124	Subsection (f) of this section on its Internet website.
125	125	(h) This section expires September 1, 2023.
126	126	SECTION 4. The changes in law made by this Act apply only to
127	127	a health benefit plan that is delivered, issued for delivery, or
128	128	renewed on or after January 1, 2022. A health benefit plan
129	129	delivered, issued for delivery, or renewed before January 1, 2022,
130	130	is governed by the law as it existed immediately before the
131	131	effective date of this Act, and that law is continued in effect for
132	132	that purpose.
133	133	SECTION 5. This Act takes effect September 1, 2021.