Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans.
Impact
The legislation amends the Insurance Code to require that any changes in drug coverage must be communicated to both the commission and affected enrollees at least 60 days prior to the change. Changes that are not allowed include removing drugs from formulary lists or imposing higher out-of-pocket costs for previously covered medications. Such legal protections pertaining to the renewal of health plans aim to stabilize drug benefits for enrollees and tackle common insurer practices that may lead to sudden increases in patient costs or discontinuation of critical medications.
Summary
Senate Bill 1142 aims to regulate modifications of prescription drug benefits within certain health benefit plans in Texas. The bill emphasizes that health benefit plan issuers cannot alter an enrollee's contracted benefit level for any prescription drug that was already approved or covered in the previous plan year unless specific conditions are met. This policy aims to ensure continuity of care and highlights the importance of prescribed medications in the treatment of medical conditions or mental illnesses.
Contention
Despite its intended protections, the bill may face contention from health benefit plan issuers who may argue that the regulations limit their flexibility in managing drug formularies and cost structures. Opponents may also assert that while the bill protects certain aspects of patient rights, it does not address the broader issues of prescription drug affordability and access. Additionally, the exclusion of specific health benefit plans such as Medicare supplemental policies from the scope of this bill could raise concerns about equity in health care access among different groups of patients.