| |
| |
| |
|
|
AN ACT
|
|
|
relating to amounts charged to an enrollee in a health benefit plan |
|
|
for prescription drugs covered by the plan. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1369.001, Insurance Code, is amended by |
|
|
adding Subdivision (2-a) to read as follows: |
|
|
(2-a) "Enrollee" means an individual who is covered |
|
|
under a health benefit plan, including a covered dependent. |
|
|
SECTION 2. Subchapter A, Chapter 1369, Insurance Code, is |
|
|
amended by adding Section 1369.0041 to read as follows: |
|
|
Sec. 1369.0041. CERTAIN PAYMENTS AND REFILLS. (a) A |
|
|
health benefit plan issuer that covers prescription drugs may not |
|
|
require an enrollee to make a payment for a prescription drug at the |
|
|
point of sale in an amount greater than the lesser of: |
|
|
(1) the applicable copayment; |
|
|
(2) the allowable claim amount for the prescription |
|
|
drug; or |
|
|
(3) the amount an individual would pay for the drug if |
|
|
the individual purchased the drug without using a health benefit |
|
|
plan or any other source of drug benefits or discounts. |
|
|
(b) A health benefit plan that covers prescription eye drops |
|
|
to treat a chronic eye disease or condition must allow the refill of |
|
|
prescription eye drops if the enrollee timely pays at the point of |
|
|
sale the maximum amount allowed by Subsection (a) and: |
|
|
(1) the original prescription states that additional |
|
|
quantities of the eye drops are needed; |
|
|
(2) the refill does not exceed the total quantity of |
|
|
dosage units authorized by the prescribing provider on the original |
|
|
prescription, including refills; and |
|
|
(3) the refill is dispensed on or before the last day |
|
|
of the prescribed dosage period and: |
|
|
(A) not earlier than the 21st day after the date a |
|
|
prescription for a 30-day supply of eye drops is dispensed; |
|
|
(B) not earlier than the 42nd day after the date a |
|
|
prescription for a 60-day supply of eye drops is dispensed; or |
|
|
(C) not earlier than the 63rd day after the date a |
|
|
prescription for a 90-day supply of eye drops is dispensed. |
|
|
SECTION 3. Section 1369.0041, Insurance Code, as added by |
|
|
this Act, applies only to a health benefit plan that is delivered, |
|
|
issued for delivery, or renewed on or after January 1, 2018. A plan |
|
|
delivered, issued for delivery, or renewed before January 1, 2018, |
|
|
is governed by the law as it existed immediately before the |
|
|
effective date of this Act, and that law is continued in effect for |
|
|
that purpose. |
|
|
SECTION 4. This Act takes effect September 1, 2017. |
|
|
|
|
|
|
| |
| |
| |
| |
______________________________ |
______________________________ |
| |
President of the Senate |
Speaker of the House |
| |
|
|
I hereby certify that S.B. No. 1076 passed the Senate on |
|
|
April 19, 2017, by the following vote: Yeas 30, Nays 1; and that |
|
|
the Senate concurred in House amendments on May 26, 2017, by the |
|
|
following vote: Yeas 30, Nays 1. |
|
|
|
| |
| |
______________________________ |
| |
Secretary of the Senate |
| |
|
|
I hereby certify that S.B. No. 1076 passed the House, with |
|
|
amendments, on May 21, 2017, by the following vote: Yeas 131, |
|
|
Nays 10, one present not voting. |
|
|
|
| |
| |
______________________________ |
| |
Chief Clerk of the House |
| |
|
|
|
| |
|
|
Approved: |
|
|
|
|
|
______________________________ |
|
|
Date |
|
|
|
|
|
|
|
|
______________________________ |
|
|
Governor |