HBA-TYH H.B. 2495 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2495
By: Farabee
Insurance
4/19/1999
Introduced



BACKGROUND AND PURPOSE 

A formulary is a list of prescription drugs that a health plan will pay
for.  As managed care has grown, health plans have increasingly relied on
formularies to control the rising cost of prescription medicines.
Consumers with specific prescription drug needs often choose a health plan
based on whether the prescription drug they require is part of the health
plan's formulary.  Currently, if a health plan changes the formulary in the
middle of a contract period during which time a consumer is unable to
change coverage, the consumer is left with a health plan that lacks the
drug needed for the consumer's medical condition or mental illness.  H.B.
2495 requires group health plans to continue covering a medication that
used to be on its formulary for the remainder of the contract period.   

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Article 21.52J, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.52J, as follows: 
 
Art. 21.52J.  USE OF PRESCRIPTION DRUG FORMULARY BY GROUP HEALTH BENEFIT
PLAN  
 
Sec. 1.  DEFINITION.  Defines "group health benefit plan." 

Sec. 2.  SCOPE OF ARTICLE. Sets forth the scope of this article, specifying
the plans that are applicable and the plans that are not applicable. 
 
Sec. 3.  CHANGES TO PRESCRIPTION DRUG FORMULARY; CONTINUATION OF BENEFITS
REQUIRED.  Requires a group health benefit plan that covers prescription
drugs, uses a formulary to specify which prescription drugs the plan will
cover, and removes from its formulary a prescription drug that the plan had
previously included in the formulary for a medical condition, to continue
to provide benefits for the drug for an enrollee if the enrollee's
prescribing health care provider prescribed the drug for the enrollee
before the drug was removed from the formulary and continues to prescribe
the drug for the same condition. Provides that a group health benefit plan
must continue to cover the drug for the enrollee of this section until the
enrollee's plan renewal date.  
 
Sec. 4.  RULES. Authorizes the commissioner of insurance to adopt rules to
implement this article.  

SECTION 2.  Effective date: September 1, 1999.
Makes application of this Act prospective.

SECTION 3.  Emergency clause.