By Luna                                               H.B. No. 3420

         75R9347 DLF-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to prescription drug coverage under health plans offered

 1-3     by health maintenance organizations.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  The Texas Health Maintenance Organization Act

 1-6     (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding

 1-7     Section 14A to read as follows:

 1-8           Sec. 14A.  COPAYMENTS FOR PRESCRIPTION DRUGS.  A health

 1-9     maintenance organization may not apply a copayment or similar

1-10     charge under a health care plan to a benefit for a prescription

1-11     drug to the extent that the copayment or charge exceeds the usual

1-12     and customary amount charged for the prescription drug by the

1-13     pharmacy that is filling the prescription.

1-14           SECTION 2.  This Act takes effect September 1, 1997, and

1-15     applies only to coverage under an evidence of coverage that is

1-16     delivered, issued for delivery, or renewed on or after January 1,

1-17     1998.  An evidence of coverage that is delivered, issued for

1-18     delivery, or renewed before January 1, 1998, is governed by the law

1-19     as it existed immediately before the effective date of this Act,

1-20     and that law is continued in effect for that purpose.

1-21           SECTION 3.  The importance of this legislation and the

1-22     crowded condition of the calendars in both houses create an

1-23     emergency and an imperative public necessity that the

1-24     constitutional rule requiring bills to be read on three several

 2-1     days in each house be suspended, and this rule is hereby suspended.

 2-2                          COMMITTEE AMENDMENT NO. 1

 2-3           Amend HB 3420 by adding a new Section 2 to read,

 2-4           "Section 2.  STANDARDIZED PHARMACY BENEFIT CARDS.  With the

 2-5     advice and assistance of the Texas State Board of Pharmacy, the

 2-6     Commissioner shall by January 1, 1999 adopt rules that require all

 2-7     health maintenance organizations to use standardized pharmacy

 2-8     benefits cards for their insureds or enrollees that meet all of the

 2-9     requirements of the United States Department of Health and Human

2-10     Services and the National Council of Prescription Drug Programs

2-11     (NCPDP).  These include, but are not limited to, unadulterated

2-12     patient identification number, patient co-payment or cash discount

2-13     amount, and payer identification number."

2-14           Renumber the subsequent sections of the bill accordingly.

2-15                                                            Van de Putte