By Edwards H.B. No. 1721
76R4127 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to use of a drug formulary in certain health benefit
1-3 plans.
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 9A to read as follows:
1-8 Sec. 9A. DRUG FORMULARY. (a) In this section, "drug
1-9 formulary" means a schedule of prescription drugs approved for use
1-10 for which prescription drug benefits are provided under a health
1-11 care plan.
1-12 (b) A health maintenance organization that uses a drug
1-13 formulary in providing a prescription drug benefit shall provide
1-14 the benefit to an enrollee for a drug not included in the formulary
1-15 if:
1-16 (1) that drug is in a class of drugs covered under the
1-17 prescription drug benefit and has been approved and designated as
1-18 safe and effective by the United States Food and Drug
1-19 Administration in compliance with federal law; and
1-20 (2) a physician treating the enrollee under the health
1-21 care plan determines that use of that drug, rather than a drug
1-22 included in the formulary, is in the best interest of the enrollee.
1-23 SECTION 2. Subchapter A, Chapter 533, Government Code, is
1-24 amended by adding Section 533.0055 to read as follows:
2-1 Sec. 533.0055. DRUG FORMULARY. (a) In this section, "drug
2-2 formulary" means a schedule of prescription drugs approved for use
2-3 for which prescription drug benefits are provided under a managed
2-4 care plan.
2-5 (b) A managed care organization that uses a drug formulary
2-6 in providing a prescription drug benefit shall provide the benefit
2-7 to a recipient for a drug not included in the formulary if:
2-8 (1) that drug is in a class of drugs covered under the
2-9 prescription drug benefit and has been approved and designated as
2-10 safe and effective by the United States Food and Drug
2-11 Administration in compliance with federal law; and
2-12 (2) a physician treating the recipient under the
2-13 managed care plan determines that use of that drug, rather than a
2-14 drug included in the formulary, is in the best interest of the
2-15 recipient.
2-16 SECTION 3. This Act takes effect September 1, 1999.
2-17 SECTION 4. The change in law made by Section 1 of this Act
2-18 applies only to an evidence of coverage that is delivered, issued
2-19 for delivery, or renewed on or after January 1, 2000. An evidence
2-20 of coverage that is delivered, issued for delivery, or renewed
2-21 before January 1, 2000, is governed by the law as it existed
2-22 immediately before the effective date of this Act, and that law is
2-23 continued in effect for that purpose.
2-24 SECTION 5. The change in law made by Section 2 of this Act
2-25 applies only to a managed care plan provided under a contract that
2-26 is entered into or renewed on or after January 1, 2000. A managed
2-27 care plan provided under a contract that is entered into or renewed
3-1 before January 1, 2000, is governed by the law as it existed
3-2 immediately before the effective date of this Act, and that law is
3-3 continued in effect for that purpose.
3-4 SECTION 6. If, before implementing any provision of Section
3-5 2 of this Act, the Health and Human Services Commission determines
3-6 that a waiver or authorization from a federal agency is necessary
3-7 for implementation of that provision, the Health and Human Services
3-8 Commission shall request the waiver or authorization and may delay
3-9 implementing that provision until the waiver or authorization is
3-10 granted.
3-11 SECTION 7. The importance of this legislation and the
3-12 crowded condition of the calendars in both houses create an
3-13 emergency and an imperative public necessity that the
3-14 constitutional rule requiring bills to be read on three several
3-15 days in each house be suspended, and this rule is hereby suspended.