| 1 | 1 | | 87R2815 RDS-F |
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| 2 | 2 | | By: Buckingham S.B. No. 523 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the effect of certain reductions in a health benefit |
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| 8 | 8 | | plan enrollee's out-of-pocket expenses for prescription drugs on |
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| 9 | 9 | | enrollee cost-sharing requirements. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. The heading to Subchapter B, Chapter 1369, |
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| 12 | 12 | | Insurance Code, is amended to read as follows: |
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| 13 | 13 | | SUBCHAPTER B. REQUIREMENTS AFFECTING COVERAGE OF SPECIFIC |
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| 14 | 14 | | PRESCRIPTION DRUGS OR COST SHARING [SPECIFIED BY DRUG FORMULARY] |
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| 15 | 15 | | SECTION 2. Subchapter B, Chapter 1369, Insurance Code, is |
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| 16 | 16 | | amended by adding Section 1369.0542 to read as follows: |
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| 17 | 17 | | Sec. 1369.0542. EFFECT OF REDUCTIONS IN OUT-OF-POCKET |
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| 18 | 18 | | EXPENSES ON COST SHARING. An issuer of a health benefit plan that |
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| 19 | 19 | | covers prescription drugs or a pharmacy benefit manager shall apply |
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| 20 | 20 | | any third-party payment, financial assistance, discount, product |
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| 21 | 21 | | voucher, or other reduction in out-of-pocket expenses made by or on |
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| 22 | 22 | | behalf of an enrollee for a prescription drug to the enrollee's |
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| 23 | 23 | | deductible, copayment, cost-sharing responsibility, or |
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| 24 | 24 | | out-of-pocket maximum applicable to prescription drug benefits |
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| 25 | 25 | | under the enrollee's plan. |
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| 26 | 26 | | SECTION 3. Section 1369.0542, Insurance Code, as added by |
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| 27 | 27 | | this Act, applies only to a health benefit plan that is delivered, |
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| 28 | 28 | | issued for delivery, or renewed on or after January 1, 2022. A |
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| 29 | 29 | | health benefit plan delivered, issued for delivery, or renewed |
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| 30 | 30 | | before January 1, 2022, is governed by the law as it existed |
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| 31 | 31 | | immediately before the effective date of this Act, and that law is |
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| 32 | 32 | | continued in effect for that purpose. |
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| 33 | 33 | | SECTION 4. This Act takes effect September 1, 2021. |
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