Texas 2023 - 88th Regular

Texas House Bill HB999 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 999
2	2
3	3
4	4	AN ACT
5	5	relating to the effect of certain reductions in a health benefit
6	6	plan enrollee's out-of-pocket expenses for certain prescription
7	7	drugs on enrollee cost-sharing requirements.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. The heading to Subchapter B, Chapter 1369,
10	10	Insurance Code, is amended to read as follows:
11	11	SUBCHAPTER B. REQUIREMENTS AFFECTING COVERAGE OF SPECIFIC
12	12	PRESCRIPTION DRUGS OR COST SHARING [SPECIFIED BY DRUG FORMULARY]
13	13	SECTION 2. Subchapter B, Chapter 1369, Insurance Code, is
14	14	amended by adding Section 1369.0542 to read as follows:
15	15	Sec. 1369.0542. EFFECT OF REDUCTIONS IN OUT-OF-POCKET
16	16	EXPENSES ON COST SHARING. (a) This section applies only to a
17	17	reduction in out-of-pocket expenses made by or on behalf of an
18	18	enrollee for a prescription drug covered by the enrollee's health
19	19	benefit plan for which:
20	20	(1) a generic equivalent does not exist;
21	21	(2) a generic equivalent does exist but the enrollee
22	22	has obtained access to the prescription drug under the enrollee's
23	23	health benefit plan using:
24	24	(A) a prior authorization process;
25	25	(B) a step therapy protocol; or
26	26	(C) the health benefit plan issuer's exceptions
27	27	and appeals process;
28	28	(3) an interchangeable biological product does not
29	29	exist; or
30	30	(4) an interchangeable biological product does exist
31	31	but the enrollee has obtained access to the prescription drug under
32	32	the enrollee's health benefit plan using:
33	33	(A) a prior authorization process;
34	34	(B) a step therapy protocol; or
35	35	(C) the health benefit plan issuer's exceptions
36	36	and appeals process.
37	37	(b) An issuer of a health benefit plan that covers
38	38	prescription drugs or a pharmacy benefit manager shall apply any
39	39	third-party payment, financial assistance, discount, product
40	40	voucher, or other reduction in out-of-pocket expenses made by or on
41	41	behalf of an enrollee for a prescription drug to the enrollee's
42	42	deductible, copayment, cost-sharing responsibility, or
43	43	out-of-pocket maximum applicable to health benefits under the
44	44	enrollee's plan.
45	45	SECTION 3. Section 1369.0542, Insurance Code, as added by
46	46	this Act, applies only to a health benefit plan that is delivered,
47	47	issued for delivery, or renewed on or after January 1, 2024. A
48	48	health benefit plan delivered, issued for delivery, or renewed
49	49	before January 1, 2024, is governed by the law as it existed
50	50	immediately before the effective date of this Act, and that law is
51	51	continued in effect for that purpose.
52	52	SECTION 4. This Act takes effect September 1, 2023.
53	53	______________________________ ______________________________
54	54	President of the Senate Speaker of the House
55	55	I certify that H.B. No. 999 was passed by the House on April
56	56	20, 2023, by the following vote: Yeas 140, Nays 5, 1 present, not
57	57	voting.
58	58	______________________________
59	59	Chief Clerk of the House
60	60	I certify that H.B. No. 999 was passed by the Senate on May
61	61	21, 2023, by the following vote: Yeas 31, Nays 0.
62	62	______________________________
63	63	Secretary of the Senate
64	64	APPROVED: _____________________
65	65	Date
66	66	_____________________
67	67	Governor