Enrolled Bill Summary

            Senate Bill 1173 amends the Insurance Code to require the health benefit plans of the Employees Retirement System of Texas (ERS) and the Teacher Retirement System of Texas (TRS), both of which use a drug formulary in providing a prescription drug benefit, to require prior authorization for coverage of the following drug categories if the specific drug prescribed is not included in the formulary: (1) a gastrointestinal drug; (2) a cholesterol-lowering drug; (3) an anti-inflammatory drug; (4) an antihistamine drug; or (5) an antidepressant drug. The bill requires the boards of trustees of ERS and TRS to submit every six months to the comptroller and to the Legislative Budget Board a report regarding any cost savings achieved through this prior authorization requirement. The bill requires each report to cover the previous six-month period, with the initial report due September 1, 2005.

            The bill allows the board of trustees of ERS to contract for or provide a coverage plan that covers smoking cessation prescription drugs at a lower benefit level than it provides for other prescription drugs. The board also is prohibited from requiring a participant in the group benefits program to purchase a prescription drug through a mail order program. If a participant chooses to obtain a drug through a method other than mail order, the bill requires the board or the health benefit plan to require the participant to pay a deductible, a copayment, or other cost-sharing obligation to cover the additional cost of obtaining the drug through that method.