Texas 2021 - 87th Regular

Texas House Bill HB2668 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	87R24046 RDS-F
2		-	By: Price, et al. H.B. No. 2668
3		-	Substitute the following for H.B. No. 2668:
4		-	By: Oliverson C.S.H.B. No. 2668
	1	+	87R2815 RDS-F
	2	+	By: Price H.B. No. 2668
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to the effect of certain reductions in a health benefit
10		-	plan enrollee's out-of-pocket expenses for ~~certain prescription~~
11		-	~~drugs on~~ enrollee cost-sharing requirements.
	8	+	plan enrollee's out-of-pocket expenses for prescription drugs on
	9	+	enrollee cost-sharing requirements.
12	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	11		SECTION 1. The heading to Subchapter B, Chapter 1369,
14	12		Insurance Code, is amended to read as follows:
15	13		SUBCHAPTER B. REQUIREMENTS AFFECTING COVERAGE OF SPECIFIC
16	14		PRESCRIPTION DRUGS OR COST SHARING [SPECIFIED BY DRUG FORMULARY]
17	15		SECTION 2. Subchapter B, Chapter 1369, Insurance Code, is
18	16		amended by adding Section 1369.0542 to read as follows:
19	17		Sec. 1369.0542. EFFECT OF REDUCTIONS IN OUT-OF-POCKET
20		-	EXPENSES ON COST SHARING. (a) This section applies only to a
21		-	reduction in out-of-pocket expenses made by or on behalf of an
22		-	enrollee for a prescription drug for which:
23		-	(1) a generic equivalent does not exist;
24		-	(2) a generic equivalent does exist but the enrollee
25		-	has obtained access to the prescription drug under the enrollee's
26		-	health benefit plan using:
27		-	(A) a prior authorization process;
28		-	(B) a step therapy protocol; or
29		-	(C) the health benefit plan issuer's exceptions
30		-	and appeals process;
31		-	(3) an interchangeable biological product does not
32		-	exist; or
33		-	(4) an interchangeable biological product does exist
34		-	but the enrollee has obtained access to the prescription drug under
35		-	the enrollee's health benefit plan using:
36		-	(A) a prior authorization process;
37		-	(B) a step therapy protocol; or
38		-	(C) the health benefit plan issuer's exceptions
39		-	and appeals process.
40		-	(b) An issuer of a health benefit plan that covers
41		-	prescription drugs or a pharmacy benefit manager shall apply any
42		-	third-party payment, financial assistance, discount, product
	18	+	EXPENSES ON COST SHARING. An issuer of a health benefit plan that
	19	+	covers prescription drugs or a pharmacy benefit manager shall apply
	20	+	any third-party payment, financial assistance, discount, product
43	21		voucher, or other reduction in out-of-pocket expenses made by or on
44	22		behalf of an enrollee for a prescription drug to the enrollee's
45	23		deductible, copayment, cost-sharing responsibility, or
46		-	out-of-pocket maximum applicable to ~~health~~ benefits ~~under the~~
47		-	enrollee's plan.
	24	+	out-of-pocket maximum applicable to prescription drug benefits
	25	+	under the enrollee's plan.
48	26		SECTION 3. Section 1369.0542, Insurance Code, as added by
49	27		this Act, applies only to a health benefit plan that is delivered,
50	28		issued for delivery, or renewed on or after January 1, 2022. A
51	29		health benefit plan delivered, issued for delivery, or renewed
52	30		before January 1, 2022, is governed by the law as it existed
53	31		immediately before the effective date of this Act, and that law is
54	32		continued in effect for that purpose.
55	33		SECTION 4. This Act takes effect September 1, 2021.