Texas 2023 - 88th Regular

Texas Senate Bill SB622 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	S.B. No. 622
2	2
3	3
4	4	AN ACT
5	5	relating to the disclosure of certain prescription drug information
6	6	by a health benefit plan.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Chapter 1369, Insurance Code, is amended by
9	9	adding Subchapter B-2 to read as follows:
10	10	SUBCHAPTER B-2. DISCLOSURE OF CERTAIN PRESCRIPTION DRUG
11	11	INFORMATION SPECIFIED BY DRUG FORMULARY
12	12	Sec. 1369.091. DEFINITIONS. In this subchapter:
13	13	(1) "Cost-sharing information" means the actual
14	14	out-of-pocket amount an enrollee is required to pay a dispensing
15	15	pharmacy or prescribing provider for a prescription drug under the
16	16	enrollee's health benefit plan.
17	17	(2) "Drug formulary," "enrollee," and "prescription
18	18	drug" have the meanings assigned by Section 1369.051.
19	19	(3) "Standard API" means an application interface that
20	20	meets the requirements of an applicable American National Standards
21	21	Institute (ANSI) accredited standard to conform to standards
22	22	adopted under 45 C.F.R. Section 170.215.
23	23	Sec. 1369.092. APPLICABILITY OF SUBCHAPTER. (a) This
24	24	subchapter applies only to a health benefit plan that provides
25	25	benefits for medical or surgical expenses incurred as a result of a
26	26	health condition, accident, or sickness, including an individual,
27	27	group, blanket, or franchise insurance policy or insurance
28	28	agreement, a group hospital service contract, or an individual or
29	29	group evidence of coverage or similar coverage document that is
30	30	offered by:
31	31	(1) an insurance company;
32	32	(2) a group hospital service corporation operating
33	33	under Chapter 842;
34	34	(3) a health maintenance organization operating under
35	35	Chapter 843;
36	36	(4) an approved nonprofit health corporation that
37	37	holds a certificate of authority under Chapter 844;
38	38	(5) a multiple employer welfare arrangement that holds
39	39	a certificate of authority under Chapter 846;
40	40	(6) a stipulated premium company operating under
41	41	Chapter 884;
42	42	(7) a fraternal benefit society operating under
43	43	Chapter 885;
44	44	(8) a Lloyd's plan operating under Chapter 941; or
45	45	(9) an exchange operating under Chapter 942.
46	46	(b) Notwithstanding any other law, this subchapter applies
47	47	to:
48	48	(1) a small employer health benefit plan subject to
49	49	Chapter 1501, including coverage provided through a health group
50	50	cooperative under Subchapter B of that chapter;
51	51	(2) a standard health benefit plan issued under
52	52	Chapter 1507;
53	53	(3) a basic coverage plan under Chapter 1551;
54	54	(4) a basic plan under Chapter 1575;
55	55	(5) a primary care coverage plan under Chapter 1579;
56	56	(6) a plan providing basic coverage under Chapter
57	57	1601;
58	58	(7) alternative health benefit coverage offered by a
59	59	subsidiary of the Texas Mutual Insurance Company under Subchapter
60	60	M, Chapter 2054;
61	61	(8) a regional or local health care program operated
62	62	under Section 75.104, Health and Safety Code; and
63	63	(9) a self-funded health benefit plan sponsored by a
64	64	professional employer organization under Chapter 91, Labor Code.
65	65	Sec. 1369.093. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
66	66	This subchapter does not apply to an issuer or provider of health
67	67	benefits under or a pharmacy benefit manager administering pharmacy
68	68	benefits under:
69	69	(1) the state Medicaid program, including the Medicaid
70	70	managed care program operated under Chapter 533, Government Code;
71	71	(2) the child health plan program under Chapter 62,
72	72	Health and Safety Code;
73	73	(3) the TRICARE military health system; or
74	74	(4) a workers' compensation insurance policy or other
75	75	form of providing medical benefits under Title 5, Labor Code.
76	76	Sec. 1369.094. DISCLOSURE OF PRESCRIPTION DRUG
77	77	INFORMATION. (a) This section applies only with respect to a
78	78	prescription drug covered under a health benefit plan's pharmacy
79	79	benefit.
80	80	(b) A health benefit plan issuer that covers prescription
81	81	drugs shall provide information regarding a covered prescription
82	82	drug to an enrollee or the enrollee's prescribing provider on
83	83	request. The information provided must include the issuer's drug
84	84	formulary and, for the prescription drug and any formulary
85	85	alternative:
86	86	(1) the enrollee's eligibility;
87	87	(2) cost-sharing information, including any
88	88	deductible, copayment, or coinsurance, which must:
89	89	(A) be consistent with cost-sharing requirements
90	90	under the enrollee's plan;
91	91	(B) be accurate at the time the cost-sharing
92	92	information is provided; and
93	93	(C) include any variance in cost-sharing based on
94	94	the patient's preferred dispensing retail or mail-order pharmacy or
95	95	the prescribing provider; and
96	96	(3) applicable utilization management requirements.
97	97	(c) In providing the information required under Subsection
98	98	(b), a health benefit plan issuer shall:
99	99	(1) respond in real time to a request made through a
100	100	standard API;
101	101	(2) allow the use of an integrated technology or
102	102	service as necessary to provide the required information;
103	103	(3) ensure that the information provided is current no
104	104	later than one business day after the date a change is made; and
105	105	(4) provide the information if the request is made
106	106	using the drug's unique billing code and National Drug Code.
107	107	(d) A health benefit plan issuer may not:
108	108	(1) deny or delay a response to a request for
109	109	information under Subsection (b) for the purpose of blocking the
110	110	release of the information;
111	111	(2) restrict a prescribing provider from
112	112	communicating to the enrollee the information provided under
113	113	Subsection (b), information about the cash price of the drug, or any
114	114	additional information on any lower cost or clinically appropriate
115	115	alternative drug, whether or not the drug is covered under the
116	116	enrollee's plan;
117	117	(3) except as required by law, interfere with,
118	118	prevent, or materially discourage access to or the exchange or use
119	119	of the information provided under Subsection (b), including by:
120	120	(A) charging a fee to access the information;
121	121	(B) not responding to a request within the time
122	122	required by this section; or
123	123	(C) instituting a consent requirement for an
124	124	enrollee to access the information; or
125	125	(4) penalize, including by taking any action intended
126	126	to punish or discourage future similar behavior by the prescribing
127	127	provider, a prescribing provider for:
128	128	(A) disclosing the information provided under
129	129	Subsection (b); or
130	130	(B) prescribing, administering, or ordering a
131	131	lower cost or clinically appropriate alternative drug.
132	132	(e) A health benefit plan issuer with fewer than 10,000
133	133	enrollees may:
134	134	(1) register with the department to receive an
135	135	additional 12 months after the effective date of this subchapter to
136	136	comply with the requirements of this subchapter; and
137	137	(2) after the additional 12 months provided for in
138	138	Subdivision (1), request from the department a temporary exception
139	139	from one or more requirements of this section by submitting a report
140	140	to the department that demonstrates that compliance would impose an
141	141	unreasonable cost relative to the public value that would be gained
142	142	from full compliance.
143	143	SECTION 2. The changes in law made by this Act apply only to
144	144	a health benefit plan delivered, issued for delivery, or renewed on
145	145	or after January 1, 2025.
146	146	SECTION 3. This Act takes effect September 1, 2023.
147	147	______________________________ ______________________________
148	148	President of the Senate Speaker of the House
149	149	I hereby certify that S.B. No. 622 passed the Senate on
150	150	April 27, 2023, by the following vote: Yeas 31, Nays 0; and that
151	151	the Senate concurred in House amendment on May 16, 2023, by the
152	152	following vote: Yeas 30, Nays 1.
153	153	______________________________
154	154	Secretary of the Senate
155	155	I hereby certify that S.B. No. 622 passed the House, with
156	156	amendment, on May 10, 2023, by the following vote: Yeas 133,
157	157	Nays 7, two present not voting.
158	158	______________________________
159	159	Chief Clerk of the House
160	160	Approved:
161	161	______________________________
162	162	Date
163	163	______________________________
164	164	Governor