Texas 2023 - 88th Regular

Texas House Bill HB2180 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	88R4627 KBB-F
2	2	By: Harris of Anderson, Harless, Jetton, H.B. No. 2180
3	3	et al.
4	4
5	5
6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to the application of prescription drug price rebates to
9	9	reduce health benefit plan enrollee cost sharing.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 1369, Insurance Code, is amended by
12	12	adding Subchapter B-2 to read as follows:
13	13	SUBCHAPTER B-2. PRESCRIPTION DRUG PRICE REBATES
14	14	Sec. 1369.085. DEFINITIONS. In this subchapter:
15	15	(1) "Pharmacy benefit manager" and "prescription
16	16	drug" have the meanings assigned by Section 1369.501.
17	17	(2) "Price protection rebate" means a negotiated price
18	18	concession that accrues directly or indirectly to the health
19	19	benefit plan issuer or other party on behalf of the health benefit
20	20	plan issuer in the event of an increase in the wholesale acquisition
21	21	cost of a drug above a specified threshold.
22	22	(3) "Rebate" means:
23	23	(A) a negotiated price concession, including a
24	24	base price concession, without regard to whether the concession is
25	25	described as a rebate, and a reasonable estimate of any price
26	26	protection rebate or performance-based price concession that may
27	27	accrue directly or indirectly to the health benefit plan issuer
28	28	during the coverage year from a manufacturer, dispensing pharmacy,
29	29	or other party in connection with the dispensing or administration
30	30	of a prescription drug; and
31	31	(B) a reasonable estimate of each negotiated
32	32	price concession, fee, and other administrative cost that is passed
33	33	through, or is reasonably anticipated to be passed through, to the
34	34	health benefit plan issuer and reduces the health benefit plan
35	35	issuer's cost of covering a prescription drug.
36	36	Sec. 1369.086. APPLICABILITY OF SUBCHAPTER. (a) This
37	37	subchapter applies only to a health benefit plan that provides
38	38	benefits for medical or surgical expenses incurred as a result of a
39	39	health condition, accident, or sickness, including an individual,
40	40	group, blanket, or franchise insurance policy or insurance
41	41	agreement, a group hospital service contract, or an individual or
42	42	group evidence of coverage or similar coverage document that is
43	43	issued by:
44	44	(1) an insurance company;
45	45	(2) a group hospital service corporation operating
46	46	under Chapter 842;
47	47	(3) a health maintenance organization operating under
48	48	Chapter 843;
49	49	(4) an approved nonprofit health corporation that
50	50	holds a certificate of authority under Chapter 844;
51	51	(5) a multiple employer welfare arrangement that holds
52	52	a certificate of authority under Chapter 846;
53	53	(6) a stipulated premium company operating under
54	54	Chapter 884;
55	55	(7) a fraternal benefit society operating under
56	56	Chapter 885;
57	57	(8) a Lloyd's plan operating under Chapter 941; or
58	58	(9) an exchange operating under Chapter 942.
59	59	(b) Notwithstanding any other law, this subchapter applies
60	60	to:
61	61	(1) a small employer health benefit plan subject to
62	62	Chapter 1501, including coverage provided through a health group
63	63	cooperative under Subchapter B of that chapter;
64	64	(2) a standard health benefit plan issued under
65	65	Chapter 1507;
66	66	(3) a basic coverage plan under Chapter 1551;
67	67	(4) a basic plan under Chapter 1575;
68	68	(5) a primary care coverage plan under Chapter 1579;
69	69	(6) a plan providing basic coverage under Chapter
70	70	1601;
71	71	(7) health benefits provided by or through a church
72	72	benefits board under Subchapter I, Chapter 22, Business
73	73	Organizations Code;
74	74	(8) group health coverage made available by a school
75	75	district in accordance with Section 22.004, Education Code;
76	76	(9) a regional or local health care program operated
77	77	under Section 75.104, Health and Safety Code;
78	78	(10) a self-funded health benefit plan sponsored by a
79	79	professional employer organization under Chapter 91, Labor Code;
80	80	(11) county employee group health benefits provided
81	81	under Chapter 157, Local Government Code; and
82	82	(12) health and accident coverage provided by a risk
83	83	pool created under Chapter 172, Local Government Code.
84	84	Sec. 1369.087. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
85	85	This subchapter does not apply to an issuer or provider of health
86	86	benefits under or a pharmacy benefit manager administering pharmacy
87	87	benefits under:
88	88	(1) the state Medicaid program, including the Medicaid
89	89	managed care program under Chapter 533, Government Code;
90	90	(2) the child health plan program under Chapter 62,
91	91	Health and Safety Code;
92	92	(3) the TRICARE military health system; or
93	93	(4) a workers' compensation insurance policy or other
94	94	form of providing medical benefits under Title 5, Labor Code.
95	95	Sec. 1369.088. APPLICATION OF PRESCRIPTION DRUG PRICE
96	96	REBATES TO COST SHARING. (a) An enrollee's cost sharing amount for
97	97	a prescription drug shall be calculated at the point of sale based
98	98	on a price that is reduced by an amount equal to or greater than all
99	99	rebates received or to be received by the enrollee's pharmacy
100	100	benefit manager or health benefit plan issuer in connection with
101	101	the dispensing or administration of the prescription drug to the
102	102	enrollee.
103	103	(b) This section may not be interpreted to prohibit a health
104	104	benefit plan issuer or pharmacy benefit manager from decreasing an
105	105	enrollee's cost sharing amount by an amount greater than the amount
106	106	required under this section.
107	107	(c) In complying with this section, a health benefit plan
108	108	issuer or pharmacy benefit manager may not publish or otherwise
109	109	reveal information regarding the actual amount of rebates the
110	110	health benefit plan issuer or pharmacy benefit manager receives on
111	111	a product-specific, product class-specific,
112	112	manufacturer-specific, or pharmacy-specific basis. The
113	113	information is a trade secret and is confidential and excepted from
114	114	disclosure under Chapter 552, Government Code. The health benefit
115	115	plan issuer or pharmacy benefit manager may not disclose the
116	116	information:
117	117	(1) directly or indirectly;
118	118	(2) in a manner that would allow for the
119	119	identification of an individual product, a class of products, the
120	120	manufacturer, or the pharmacy; or
121	121	(3) in a manner that would have the potential to
122	122	compromise the financial, competitive, or proprietary nature of the
123	123	information.
124	124	(d) A health benefit plan issuer or pharmacy benefit manager
125	125	shall ensure a third party or vendor who contracts with the health
126	126	benefit plan issuer or pharmacy benefit manager and may receive or
127	127	have access to rebate information complies with the confidentiality
128	128	required by this section.
129	129	SECTION 2. Subchapter B-2, Chapter 1369, Insurance Code, as
130	130	added by this Act, applies only to a health benefit plan delivered,
131	131	issued for delivery, or renewed on or after January 1, 2024.
132	132	SECTION 3. This Act takes effect September 1, 2023.