Texas 2023 - 88th Regular

Texas House Bill HB1754 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R22472 KBB-D
2	2	By: Smithee H.B. No. 1754
3	3	Substitute the following for H.B. No. 1754:
4	4	By: Oliverson C.S.H.B. No. 1754
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the disclosure of certain prescription drug information
10	10	by a health benefit plan.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1369, Insurance Code, is amended by
13	13	adding Subchapter B-2 to read as follows:
14	14	SUBCHAPTER B-2. DISCLOSURE OF CERTAIN PRESCRIPTION DRUG
15	15	INFORMATION SPECIFIED BY DRUG FORMULARY
16	16	Sec. 1369.091. DEFINITIONS. In this subchapter:
17	17	(1) "Cost-sharing information" means the actual
18	18	out-of-pocket amount an enrollee is required to pay a dispensing
19	19	pharmacy or prescribing provider for a prescription drug under the
20	20	enrollee's health benefit plan.
21	21	(2) "Drug formulary," "enrollee," and "prescription
22	22	drug" have the meanings assigned by Section 1369.051.
23	23	(3) "Standard API" means an application interface that
24	24	meets the requirements of an applicable American National Standards
25	25	Institute (ANSI) accredited standard to conform to standards
26	26	adopted under 45 C.F.R. Section 170.215.
27	27	Sec. 1369.092. APPLICABILITY OF SUBCHAPTER. (a) This
28	28	subchapter applies only to a health benefit plan that provides
29	29	benefits for medical or surgical expenses incurred as a result of a
30	30	health condition, accident, or sickness, including an individual,
31	31	group, blanket, or franchise insurance policy or insurance
32	32	agreement, a group hospital service contract, or an individual or
33	33	group evidence of coverage or similar coverage document that is
34	34	offered by:
35	35	(1) an insurance company;
36	36	(2) a group hospital service corporation operating
37	37	under Chapter 842;
38	38	(3) a health maintenance organization operating under
39	39	Chapter 843;
40	40	(4) an approved nonprofit health corporation that
41	41	holds a certificate of authority under Chapter 844;
42	42	(5) a multiple employer welfare arrangement that holds
43	43	a certificate of authority under Chapter 846;
44	44	(6) a stipulated premium company operating under
45	45	Chapter 884;
46	46	(7) a fraternal benefit society operating under
47	47	Chapter 885;
48	48	(8) a Lloyd's plan operating under Chapter 941; or
49	49	(9) an exchange operating under Chapter 942.
50	50	(b) Notwithstanding any other law, this subchapter applies
51	51	to:
52	52	(1) a small employer health benefit plan subject to
53	53	Chapter 1501, including coverage provided through a health group
54	54	cooperative under Subchapter B of that chapter;
55	55	(2) a standard health benefit plan issued under
56	56	Chapter 1507;
57	57	(3) a basic coverage plan under Chapter 1551;
58	58	(4) a basic plan under Chapter 1575;
59	59	(5) a primary care coverage plan under Chapter 1579;
60	60	(6) a plan providing basic coverage under Chapter
61	61	1601;
62	62	(7) nonprofit agricultural organization health
63	63	benefits offered by a nonprofit agricultural organization under
64	64	Chapter 1682;
65	65	(8) alternative health benefit coverage offered by a
66	66	subsidiary of the Texas Mutual Insurance Company under Subchapter
67	67	M, Chapter 2054;
68	68	(9) a regional or local health care program operated
69	69	under Section 75.104, Health and Safety Code; and
70	70	(10) a self-funded health benefit plan sponsored by a
71	71	professional employer organization under Chapter 91, Labor Code.
72	72	Sec. 1369.093. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
73	73	This subchapter does not apply to an issuer or provider of health
74	74	benefits under or a pharmacy benefit manager administering pharmacy
75	75	benefits under:
76	76	(1) the state Medicaid program, including the Medicaid
77	77	managed care program operated under Chapter 533, Government Code;
78	78	(2) the child health plan program under Chapter 62,
79	79	Health and Safety Code;
80	80	(3) the TRICARE military health system; or
81	81	(4) a workers' compensation insurance policy or other
82	82	form of providing medical benefits under Title 5, Labor Code.
83	83	Sec. 1369.094. DISCLOSURE OF PRESCRIPTION DRUG
84	84	INFORMATION. (a) This section applies only with respect to a
85	85	prescription drug covered under a health benefit plan's pharmacy
86	86	benefit.
87	87	(b) A health benefit plan issuer that covers prescription
88	88	drugs shall provide information regarding a covered prescription
89	89	drug to an enrollee or the enrollee's prescribing provider on
90	90	request. The information provided must include the issuer's drug
91	91	formulary and, for the prescription drug and any formulary
92	92	alternative:
93	93	(1) the enrollee's eligibility;
94	94	(2) cost-sharing information, including any
95	95	deductible, copayment, or coinsurance, which must:
96	96	(A) be consistent with cost-sharing requirements
97	97	under the enrollee's plan;
98	98	(B) be accurate at the time the cost-sharing
99	99	information is provided; and
100	100	(C) include any variance in cost-sharing based on
101	101	the patient's preferred dispensing retail or mail-order pharmacy or
102	102	the prescribing provider; and
103	103	(3) applicable utilization management requirements.
104	104	(c) In providing the information required under Subsection
105	105	(b), a health benefit plan issuer shall:
106	106	(1) respond in real time to a request made through a
107	107	standard API;
108	108	(2) allow the use of an integrated technology or
109	109	service as necessary to provide the required information;
110	110	(3) ensure that the information provided is current no
111	111	later than one business day after the date a change is made; and
112	112	(4) provide the information if the request is made
113	113	using the drug's unique billing code and National Drug Code.
114	114	(d) A health benefit plan issuer may not:
115	115	(1) deny or delay a response to a request for
116	116	information under Subsection (b) for the purpose of blocking the
117	117	release of the information;
118	118	(2) restrict a prescribing provider from
119	119	communicating to the enrollee the information provided under
120	120	Subsection (b), information about the cash price of the drug, or any
121	121	additional information on any lower cost or clinically appropriate
122	122	alternative drug, whether or not the drug is covered under the
123	123	enrollee's plan;
124	124	(3) except as required by law, interfere with,
125	125	prevent, or materially discourage access to or the exchange or use
126	126	of the information provided under Subsection (b), including by:
127	127	(A) charging a fee to access the information;
128	128	(B) not responding to a request within the time
129	129	required by this section; or
130	130	(C) instituting a consent requirement for an
131	131	enrollee to access the information; or
132	132	(4) penalize, including by taking any action intended
133	133	to punish or discourage future similar behavior by the prescribing
134	134	provider, a prescribing provider for:
135	135	(A) disclosing the information provided under
136	136	Subsection (b); or
137	137	(B) prescribing, administering, or ordering a
138	138	lower cost or clinically appropriate alternative drug.
139	139	(e) A health benefit plan issuer with fewer than 10,000
140	140	enrollees may:
141	141	(1) register with the department to receive an
142	142	additional 12 months after the effective date of this subchapter to
143	143	comply with the requirements of this subchapter; and
144	144	(2) after the additional 12 months provided for in
145	145	Subdivision (1), request from the department a temporary exception
146	146	from one or more requirements of this section by submitting a report
147	147	to the department that demonstrates that compliance would impose an
148	148	unreasonable cost relative to the public value that would be gained
149	149	from full compliance.
150	150	SECTION 2. The changes in law made by this Act apply only to
151	151	a health benefit plan delivered, issued for delivery, or renewed on
152	152	or after January 1, 2025.
153	153	SECTION 3. This Act takes effect September 1, 2023.