SRC-AXB, DBM S.B. 1687 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 1687
76R6096  DLF-FBy: Bernsen
Economic Development
5/13/1999
As Filed


DIGEST 

Currently, many health benefit plans that offer prescription drug benefits
do so through a network of pharmacies with whom the plans have been
contracted.  Some policies offer prescription benefits that are limited to
mail order prescriptions or generic drug formalities.  S.B. 1687 would set
forth provisions regarding the availability of prescription drugs from
certain pharmacies under a health care plan offered by a health maintenance
organization. 


PURPOSE

As proposed, S.B. 1687 sets forth provisions regarding the availability of
prescription drugs from certain pharmacies under a health care plan offered
by a health maintenance organization. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Texas Department of Insurance in
SECTION 1 (Section 40(f), Chapter 20A, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 20A, Insurance Code (Texas Health Maintenance
Organization Act), by adding Section 40, as follow: 

Sec. 40.  USE OF OUT-OF-NETWORK PHARMACIES.  Defines "network pharmacy,"
and "out-of-network pharmacy."  Authorizes an enrollee to select an
out-of-network pharmacy to provide prescription drugs to the enrollee.
Requires a health maintenance organization (HMO) to pay the out-of-network
pharmacy an amount equal to the amount the HMO would pay to a network
pharmacy for the same prescription drug.  Provides that, notwithstanding
any other law, an enrollee who selects an out-of-network pharmacy under
Subsection (b) of this section is responsible for any amount charged for a
prescription drug by that pharmacy that exceeds the amount paid by the HMO.
Provides that this section does not require a HMO to provide benefits for
certain prescription drugs.  Requires the Texas Department of Insurance
(department) to adopt rules to implement this section. 

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

SECTION 3.Emergency clause.