Texas 2021 - 87th Regular

Texas House Bill HB82 Compare Versions

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

Old	New	Differences
1	1	87R1857 SMT-F
2	2	By: Lucio III H.B. No. 82
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. Chapter 1358, Insurance Code, is amended by
11	11	adding Subchapter C to read as follows:
12	12	SUBCHAPTER C. COST-SHARING LIMIT
13	13	Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This
14	14	subchapter applies only to a health benefit plan that provides
15	15	benefits for medical or surgical expenses incurred as a result of a
16	16	health condition, accident, or sickness, including an individual,
17	17	group, blanket, or franchise insurance policy or insurance
18	18	agreement, a group hospital service contract, or a small or large
19	19	employer group contract or similar coverage document that is
20	20	offered by:
21	21	(1) an insurance company;
22	22	(2) a group hospital service corporation operating
23	23	under Chapter 842;
24	24	(3) a fraternal benefit society operating under
25	25	Chapter 885;
26	26	(4) a stipulated premium company operating under
27	27	Chapter 884;
28	28	(5) a reciprocal exchange operating under Chapter 942;
29	29	(6) a health maintenance organization operating under
30	30	Chapter 843;
31	31	(7) a multiple employer welfare arrangement that holds
32	32	a certificate of authority under Chapter 846; or
33	33	(8) an approved nonprofit health corporation that
34	34	holds a certificate of authority under Chapter 844.
35	35	(b) This subchapter applies to group health coverage made
36	36	available by a school district in accordance with Section 22.004,
37	37	Education Code.
38	38	(c) Notwithstanding any provision in Chapter 1551, 1575,
39	39	1579, or 1601 or any other law, this subchapter applies to:
40	40	(1) a basic coverage plan under Chapter 1551;
41	41	(2) a basic plan under Chapter 1575;
42	42	(3) a primary care coverage plan under Chapter 1579;
43	43	and
44	44	(4) basic coverage under Chapter 1601.
45	45	(d) Notwithstanding any other law, this subchapter applies
46	46	to coverage under:
47	47	(1) the child health plan program under Chapter 62,
48	48	Health and Safety Code, or the health benefits plan for children
49	49	under Chapter 63, Health and Safety Code; and
50	50	(2) the medical assistance program under Chapter 32,
51	51	Human Resources Code.
52	52	Sec. 1358.102. EXCEPTION. This subchapter does not apply
53	53	to:
54	54	(1) a health benefit plan that provides coverage:
55	55	(A) only for a specified disease or for another
56	56	single benefit;
57	57	(B) only for accidental death or dismemberment;
58	58	(C) for wages or payments in lieu of wages for a
59	59	period during which an employee is absent from work because of
60	60	sickness or injury;
61	61	(D) as a supplement to a liability insurance
62	62	policy;
63	63	(E) for credit insurance;
64	64	(F) only for dental or vision care;
65	65	(G) only for hospital expenses; or
66	66	(H) only for indemnity for hospital confinement;
67	67	(2) a Medicare supplemental policy as defined by
68	68	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
69	69	(3) medical payment insurance coverage provided under
70	70	a motor vehicle insurance policy;
71	71	(4) a long-term care insurance policy, including a
72	72	nursing home fixed indemnity policy, unless the commissioner
73	73	determines that the policy provides benefit coverage so
74	74	comprehensive that the policy is a health benefit plan as described
75	75	by Section 1358.101;
76	76	(5) health and accident coverage provided by a risk
77	77	pool created under Chapter 172, Local Government Code; or
78	78	(6) a workers' compensation insurance policy.
79	79	Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In
80	80	this section, "insulin" means a prescription drug that contains
81	81	insulin and is used to treat diabetes. The term does not include an
82	82	insulin drug that is administered to a patient intravenously.
83	83	(b) A health benefit plan may not impose a cost-sharing
84	84	provision for insulin if the total amount the enrollee is required
85	85	to pay exceeds $100 for a 30-day supply, regardless of the amount or
86	86	type of insulin needed to fill the enrollee's prescription.
87	87	SECTION 2. (a) In this section, "commission" means the
88	88	Health and Human Services Commission.
89	89	(b) The commission shall conduct a study evaluating pricing
90	90	of prescription insulin drugs to ensure adequate consumer
91	91	protections in pricing of prescription insulin drugs and consider
92	92	whether additional consumer protections are necessary.
93	93	(c) The commission shall request from health benefit plan
94	94	issuers and prescription drug manufacturers information concerning
95	95	the organization, business practices, pricing information, data,
96	96	reports, or other information the commission determines is
97	97	necessary to conduct the study. The commission shall also consider
98	98	any publicly available information related to prescription insulin
99	99	pricing.
100	100	(d) A health benefit plan issuer or prescription drug
101	101	manufacturer who receives a request from the commission under
102	102	Subsection (c) of this section shall furnish the commission with
103	103	the information as soon as practicable after the date the issuer or
104	104	manufacturer receives the request.
105	105	(e) The commission may not require a health benefit plan
106	106	issuer or prescription drug manufacturer to disclose trade secrets
107	107	in information provided to the commission under Subsection (d) of
108	108	this section.
109	109	(f) Not later than September 1, 2022, the commission shall
110	110	prepare and submit to the governor, the lieutenant governor, and
111	111	the speaker of the house of representatives a written report
112	112	containing the results of the study. The report must include:
113	113	(1) a summary of insulin pricing practices and
114	114	variables that contribute to pricing of health benefit plans;
115	115	(2) policy recommendations to control and prevent
116	116	overpricing of prescription insulin; and
117	117	(3) any other information the commission determines is
118	118	necessary.
119	119	(g) The commission shall publish the report described by
120	120	Subsection (f) of this section on its Internet website.
121	121	(h) This section expires September 1, 2023.
122	122	SECTION 3. The changes in law made by this Act apply only to
123	123	a health benefit plan that is delivered, issued for delivery, or
124	124	renewed on or after January 1, 2022. A health benefit plan
125	125	delivered, issued for delivery, or renewed before January 1, 2022,
126	126	is governed by the law as it existed immediately before the
127	127	effective date of this Act, and that law is continued in effect for
128	128	that purpose.
129	129	SECTION 4. This Act takes effect September 1, 2021.