S.B. No. 622
  relating to the disclosure of certain prescription drug information
  by a health benefit plan.
         SECTION 1.  Chapter 1369, Insurance Code, is amended by
  adding Subchapter B-2 to read as follows:
         Sec. 1369.091.  DEFINITIONS. In this subchapter:
               (1)  "Cost-sharing information" means the actual
  out-of-pocket amount an enrollee is required to pay a dispensing
  pharmacy or prescribing provider for a prescription drug under the
  enrollee's health benefit plan.
               (2)  "Drug formulary," "enrollee," and "prescription
  drug" have the meanings assigned by Section 1369.051.
               (3)  "Standard API" means an application interface that
  meets the requirements of an applicable American National Standards
  Institute (ANSI) accredited standard to conform to standards
  adopted under 45 C.F.R. Section 170.215.
         Sec. 1369.092.  APPLICABILITY OF SUBCHAPTER. (a)  This
  subchapter applies only to a health benefit plan that provides
  benefits for medical or surgical expenses incurred as a result of a
  health condition, accident, or sickness, including an individual,
  group, blanket, or franchise insurance policy or insurance
  agreement, a group hospital service contract, or an individual or
  group evidence of coverage or similar coverage document that is
  offered by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this subchapter applies
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
               (7)  alternative health benefit coverage offered by a
  subsidiary of the Texas Mutual Insurance Company under Subchapter
  M, Chapter 2054;
               (8)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (9)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
  This subchapter does not apply to an issuer or provider of health
  benefits under or a pharmacy benefit manager administering pharmacy
  benefits under:
               (1)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code;
               (2)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (3)  the TRICARE military health system; or
               (4)  a workers' compensation insurance policy or other
  form of providing medical benefits under Title 5, Labor Code.
  INFORMATION. (a)  This section applies only with respect to a
  prescription drug covered under a health benefit plan's pharmacy
         (b)  A health benefit plan issuer that covers prescription
  drugs shall provide information regarding a covered prescription
  drug to an enrollee or the enrollee's prescribing provider on
  request. The information provided must include the issuer's drug
  formulary and, for the prescription drug and any formulary
               (1)  the enrollee's eligibility;
               (2)  cost-sharing information, including any
  deductible, copayment, or coinsurance, which must:
                     (A)  be consistent with cost-sharing requirements
  under the enrollee's plan;
                     (B)  be accurate at the time the cost-sharing
  information is provided; and
                     (C)  include any variance in cost-sharing based on
  the patient's preferred dispensing retail or mail-order pharmacy or
  the prescribing provider; and
               (3)  applicable utilization management requirements.
         (c)  In providing the information required under Subsection
  (b), a health benefit plan issuer shall:
               (1)  respond in real time to a request made through a
  standard API;
               (2)  allow the use of an integrated technology or
  service as necessary to provide the required information;
               (3)  ensure that the information provided is current no
  later than one business day after the date a change is made; and
               (4)  provide the information if the request is made
  using the drug's unique billing code and National Drug Code.
         (d)  A health benefit plan issuer may not:
               (1)  deny or delay a response to a request for
  information under Subsection (b) for the purpose of blocking the
  release of the information;
               (2)  restrict a prescribing provider from
  communicating to the enrollee the information provided under
  Subsection (b), information about the cash price of the drug, or any
  additional information on any lower cost or clinically appropriate
  alternative drug, whether or not the drug is covered under the
  enrollee's plan;
               (3)  except as required by law, interfere with,
  prevent, or materially discourage access to or the exchange or use
  of the information provided under Subsection (b), including by:
                     (A)  charging a fee to access the information;
                     (B)  not responding to a request within the time
  required by this section; or
                     (C)  instituting a consent requirement for an
  enrollee to access the information; or
               (4)  penalize, including by taking any action intended
  to punish or discourage future similar behavior by the prescribing
  provider, a prescribing provider for:
                     (A)  disclosing the information provided under
  Subsection (b); or
                     (B)  prescribing, administering, or ordering a
  lower cost or clinically appropriate alternative drug.
         (e)  A health benefit plan issuer with fewer than 10,000
  enrollees may:
               (1)  register with the department to receive an
  additional 12 months after the effective date of this subchapter to
  comply with the requirements of this subchapter; and
               (2)  after the additional 12 months provided for in
  Subdivision (1), request from the department a temporary exception
  from one or more requirements of this section by submitting a report
  to the department that demonstrates that compliance would impose an
  unreasonable cost relative to the public value that would be gained
  from full compliance.
         SECTION 2.  The changes in law made by this Act apply only to
  a health benefit plan delivered, issued for delivery, or renewed on
  or after January 1, 2025.
         SECTION 3.  This Act takes effect September 1, 2023.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I hereby certify that S.B. No. 622 passed the Senate on
  April 27,  2023, by the following vote: Yeas 31, Nays 0; and that
  the Senate concurred in House amendment on May 16, 2023, by the
  following vote: Yeas 30, Nays 1.
  Secretary of the Senate    
         I hereby certify that S.B. No. 622 passed the House, with
  amendment, on May 10, 2023, by the following vote: Yeas 133,
  Nays 7, two present not voting.
  Chief Clerk of the House