Texas 2021 - 87th Regular

Texas Senate Bill SB166 Compare Versions

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

Old	New	Differences
1	1	87R1900 SMT-F
2	2	By: Blanco S.B. No. 166
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a limit on cost-sharing requirements imposed by a
8	8	health benefit plan for certain 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. DEFINITIONS. In this subchapter:
14	14	(1) "Insulin" means a prescription drug that contains
15	15	insulin and is used to treat diabetes.
16	16	(2) "Pharmacy benefit manager" means a person, other
17	17	than a pharmacy or pharmacist, who acts as an administrator in
18	18	connection with pharmacy benefits.
19	19	Sec. 1358.102. APPLICABILITY OF SUBCHAPTER. (a) This
20	20	subchapter applies only to a health benefit plan that provides
21	21	benefits for medical or surgical expenses incurred as a result of a
22	22	health condition, accident, or sickness, including an individual,
23	23	group, blanket, or franchise insurance policy or insurance
24	24	agreement, a group hospital service contract, or an individual or
25	25	group evidence of coverage or similar coverage document that is
26	26	issued by:
27	27	(1) an insurance company;
28	28	(2) a group hospital service corporation operating
29	29	under Chapter 842;
30	30	(3) a health maintenance organization operating under
31	31	Chapter 843;
32	32	(4) an approved nonprofit health corporation that
33	33	holds a certificate of authority under Chapter 844;
34	34	(5) a multiple employer welfare arrangement that holds
35	35	a certificate of authority under Chapter 846;
36	36	(6) a stipulated premium company operating under
37	37	Chapter 884;
38	38	(7) a fraternal benefit society operating under
39	39	Chapter 885;
40	40	(8) a Lloyd's plan operating under Chapter 941; or
41	41	(9) an exchange operating under Chapter 942.
42	42	(b) Notwithstanding any other law, this subchapter applies
43	43	to:
44	44	(1) a small employer health benefit plan subject to
45	45	Chapter 1501, including coverage provided through a health group
46	46	cooperative under Subchapter B of that chapter;
47	47	(2) a standard health benefit plan issued under
48	48	Chapter 1507;
49	49	(3) a basic coverage plan under Chapter 1551;
50	50	(4) a basic plan under Chapter 1575;
51	51	(5) a primary care coverage plan under Chapter 1579;
52	52	(6) a plan providing basic coverage under Chapter
53	53	1601;
54	54	(7) health benefits provided by or through a church
55	55	benefits board under Subchapter I, Chapter 22, Business
56	56	Organizations Code;
57	57	(8) group health coverage made available by a school
58	58	district in accordance with Section 22.004, Education Code;
59	59	(9) the state Medicaid program, including the Medicaid
60	60	managed care program operated under Chapter 533, Government Code;
61	61	(10) the child health plan program under Chapter 62,
62	62	Health and Safety Code;
63	63	(11) a regional or local health care program operated
64	64	under Section 75.104, Health and Safety Code; and
65	65	(12) a self-funded health benefit plan sponsored by a
66	66	professional employer organization under Chapter 91, Labor Code.
67	67	(c) This subchapter applies to coverage under a group health
68	68	benefit plan provided to a resident of this state regardless of
69	69	whether the group policy, agreement, or contract is delivered,
70	70	issued for delivery, or renewed in this state.
71	71	Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. A
72	72	health benefit plan may not impose a cost-sharing provision for
73	73	insulin if the total amount the enrollee is required to pay exceeds
74	74	$25 for a 30-day supply.
75	75	Sec. 1358.104. LIMITATION ON PHARMACY CONTRACTS. A
76	76	contract between a health benefit plan issuer or pharmacy benefit
77	77	manager and a pharmacy may not contain a provision:
78	78	(1) authorizing the issuer's pharmacy benefit manager
79	79	or the pharmacy to charge an amount for insulin greater than the
80	80	amount described by Section 1358.103;
81	81	(2) requiring the pharmacy to collect an amount for
82	82	insulin greater than the amount described by Section 1358.103; or
83	83	(3) requiring an enrollee to make a cost-sharing
84	84	payment for covered insulin in an amount that exceeds the amount
85	85	described by Section 1358.103.
86	86	SECTION 2. (a) Section 1358.103, Insurance Code, as added
87	87	by this Act, applies only to a health benefit plan that is
88	88	delivered, issued for delivery, or renewed on or after January 1,
89	89	2022. A health benefit plan delivered, issued for delivery, or
90	90	renewed before January 1, 2022, is governed by the law as it existed
91	91	immediately before the effective date of this Act, and that law is
92	92	continued in effect for that purpose.
93	93	(b) Section 1358.104, Insurance Code, as added by this Act,
94	94	applies only to a contract entered into or renewed on or after the
95	95	effective date of this Act.
96	96	SECTION 3. This Act takes effect September 1, 2021.