By Farabee H.B. No. 2495 76R7522 DLF-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the use of a prescription drug formulary by a group 1-3 health benefit plan. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-6 amended by adding Article 21.52J to read as follows: 1-7 Art. 21.52J. USE OF PRESCRIPTION DRUG FORMULARY BY GROUP 1-8 HEALTH BENEFIT PLAN 1-9 Sec. 1. DEFINITION. In this article, "group health benefit 1-10 plan" means a health benefit plan described by Section 2 of this 1-11 article. 1-12 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-13 a group health benefit plan that provides benefits for medical or 1-14 surgical expenses incurred as a result of a health condition, 1-15 accident, or sickness, including a group, blanket, or franchise 1-16 insurance policy or insurance agreement, a group hospital service 1-17 contract, or a group contract or similar coverage document that is 1-18 offered by: 1-19 (1) an insurance company; 1-20 (2) a group hospital service corporation operating 1-21 under Chapter 20 of this code; 1-22 (3) a fraternal benefit society operating under 1-23 Chapter 10 of this code; 1-24 (4) a stipulated premium insurance company operating 2-1 under Chapter 22 of this code; 2-2 (5) a reciprocal exchange operating under Chapter 19 2-3 of this code; 2-4 (6) a health maintenance organization operating under 2-5 the Texas Health Maintenance Organization Act (Chapter 20A, 2-6 Vernon's Texas Insurance Code); 2-7 (7) a multiple employer welfare arrangement that holds 2-8 a certificate of authority under Article 3.95-2 of this code; or 2-9 (8) an approved nonprofit health corporation that 2-10 holds a certificate of authority issued by the commissioner under 2-11 Article 21.52F of this code. 2-12 (b) This article does not apply to: 2-13 (1) a plan that provides coverage: 2-14 (A) only for a specified disease or other 2-15 limited benefit; 2-16 (B) only for accidental death or dismemberment; 2-17 (C) for wages or payments in lieu of wages for a 2-18 period during which an employee is absent from work because of 2-19 sickness or injury; 2-20 (D) as a supplement to liability insurance; 2-21 (E) for credit insurance; 2-22 (F) only for dental or vision care; 2-23 (G) only for hospital expenses; or 2-24 (H) only for indemnity for hospital confinement; 2-25 (2) a small employer health benefit plan written under 2-26 Chapter 26 of this code; 2-27 (3) a Medicare supplemental policy as defined by 3-1 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 3-2 as amended; 3-3 (4) workers' compensation insurance coverage; 3-4 (5) medical payment insurance coverage issued as part 3-5 of a motor vehicle insurance policy; or 3-6 (6) a long-term care policy, including a nursing home 3-7 fixed indemnity policy, unless the commissioner determines that the 3-8 policy provides benefit coverage so comprehensive that the policy 3-9 is a health benefit plan as described by Subsection (a) of this 3-10 section. 3-11 Sec. 3. CHANGES TO PRESCRIPTION DRUG FORMULARY; CONTINUATION 3-12 OF BENEFITS REQUIRED. (a) A group health benefit plan that covers 3-13 prescription drugs, uses a formulary to specify which prescription 3-14 drugs the plan will cover, and removes from its formulary a 3-15 prescription drug that the plan had previously included in the 3-16 formulary for a medical condition, shall continue to provide 3-17 benefits for the drug for an enrollee if the enrollee's prescribing 3-18 health care provider: 3-19 (1) prescribed the drug for the enrollee before the 3-20 drug was removed from the formulary; and 3-21 (2) continues to prescribe the drug for the same 3-22 condition. 3-23 (b) A group health benefit plan must continue to cover the 3-24 drug for the enrollee under Subsection (a) of this section until 3-25 the enrollee's plan renewal date. 3-26 Sec. 4. RULES. The commissioner may adopt rules to implement 3-27 this article. 4-1 SECTION 2. This Act takes effect September 1, 1999, and 4-2 applies only to a group health benefit plan that is delivered, 4-3 issued for delivery, or renewed on or after January 1, 2000. A 4-4 group health benefit plan delivered, issued for delivery, or 4-5 renewed before January 1, 2000, is governed by the law as it 4-6 existed immediately before the effective date of this Act, and that 4-7 law is continued in effect for that purpose. 4-8 SECTION 3. The importance of this legislation and the 4-9 crowded condition of the calendars in both houses create an 4-10 emergency and an imperative public necessity that the 4-11 constitutional rule requiring bills to be read on three several 4-12 days in each house be suspended, and this rule is hereby suspended.