By: Talarico H.B. No. 40
A BILL TO BE ENTITLED
AN ACT
relating to a cap on the monthly price of insulin and insulin
supplies.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1358, Insurance Code, is amended by
adding Section 1358.058 to read as follows:
Sec. 1358.058. COST SHARING IN PRESCRIPTION INSULIN DRUGS -
LIMITS CONFIDENTIALITY OF REBATE INFORMATION - DEFINITION -RULES.
(1) As used in this section, unless the context other
requires, "prescription insulin drug" means a prescription drug, as
defined in section 1358.051, that contains insulin and is used to
treat diabetes.
(2) a carrier that provides coverage for prescription
insulin drugs pursuant to the terms of a health coverage plan the
carrier offers shall cap the total amount that a covered person is
required to pay for a covered prescription insulin drug at an amount
not to exceed one hundred dollars per thirty-day supply of insulin,
regardless of the amount or type of insulin needed to fill the
covered person's prescription.
(3) nothing in this section prevents a carrier from
reducing a covered person's cost sharing by an amount greater than
the amount specified in subsection (2) of this section.
(4) This section applies to health coverage plans
offered by the Employees Retirement System of Texas and the Teacher
Retirement System of Texas.
(5) the commissioner may use any of the commissioner's
enforcement powers to obtain a carrier's compliance with this
section.
(6) the commissioner may promulgate rules as necessary
to implement and administer this section and to align with federal
requirements.
SECTION 2. Chapter 1358, Insurance Code, is amended by
adding Section 1358.059 to read as follows:
Sec. 1358.059. INVESTIGATION AND REPORTING OF PRESCRIPTION
INSULIN DRUG PRICING. (a) The Department of Health and Human
Services shall investigate and report on the pricing of
prescription insulin drugs
(1) made available to Texas consumers to ensure
adequate consumer protections in pricing of prescription insulin
drugs and whether additional consumer protections are needed.
(2) (a) as part of the investigation by the
department, the department shall gather, compile, and analyze
information concerning the organization, business practices,
pricing information, data, reports, or other information that the
department finds necessary to fulfill the requirements of this
section from companies engaged in the manufacture or sale of
prescription insulin drugs. The department shall also consider any
publicly available information related to drug pricing.
(b) if necessary to fulfill the reporting
requirements of this section, the attorney general may issue a
civil investigative demand requiring a state department; carrier;
pharmacy benefit management firm; or manufacturer of prescription
insulin drugs that are made available in Texas, to furnish
material, answers, data, or other relevant information.
(3) a person or business shall not be compelled to
provide trade secrets.
(4) by September 1, 2022, the department shall issue
and make available to the public a report detailing its findings
from the investigation conducted pursuant to this section. The
department shall present the report to the Governor, the Lieutenant
Governor, the Speaker of the House, and the Senate Committee on
Business and Commerce and the House Committee on Insurance or their
successor committees. The report must include:
(a) a summary of insulin pricing practices and
variables that contribute to pricing of health coverage plans;
(b) public policy recommendations to control and
prevent overpricing of prescription insulin drugs made available to
Texas consumers;
(c) any recommendations to improve consumer
protections, to prevent deceptive sales practices related to the
sale of prescription insulin drugs, including the pricing of those
drugs; and
(d) any other information the department finds
necessary.
(5) this section is repealed, effective December 1,
2022.
SECTION 3. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2022. A health benefit plan that is delivered, issued for
delivery, or renewed before January 1, 2022, 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 7. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2021.