By Wise H.B. No. 3663 76R7060 DLF-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to network pharmacies under certain health benefit plans. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-5 amended by adding Article 21.52K to read as follows: 1-6 Art. 21.52K. MINIMUM NUMBER OF NETWORK PHARMACIES 1-7 Sec. 1. DEFINITIONS. In this article: 1-8 (1) "Health benefit plan" means a health benefit plan 1-9 described by Section 2 of this article. 1-10 (2) "Network pharmacy" means a pharmacy that, under 1-11 contract to the issuer of a health benefit plan, provides 1-12 pharmaceutical services and prescription drugs to enrollees in the 1-13 health benefit plan. 1-14 (3) "Pharmacy" means a facility licensed as a pharmacy 1-15 under the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil 1-16 Statutes). 1-17 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-18 a health benefit plan that provides benefits for medical or 1-19 surgical expenses incurred as a result of a health condition, 1-20 accident, or sickness, including an individual, group, blanket, or 1-21 franchise insurance policy or insurance agreement, a group hospital 1-22 service contract, or an individual or group evidence of coverage or 1-23 similar coverage document that is offered by: 1-24 (1) an insurance company; 2-1 (2) a group hospital service corporation operating 2-2 under Chapter 20 of this code; 2-3 (3) a fraternal benefit society operating under 2-4 Chapter 10 of this code; 2-5 (4) a stipulated premium insurance company operating 2-6 under Chapter 22 of this code; 2-7 (5) a reciprocal exchange operating under Chapter 19 2-8 of this code; 2-9 (6) a health maintenance organization operating under 2-10 the Texas Health Maintenance Organization Act (Chapter 20A, 2-11 Vernon's Texas Insurance Code); 2-12 (7) a multiple employer welfare arrangement that holds 2-13 a certificate of authority under Article 3.95-2 of this code; or 2-14 (8) an approved nonprofit health corporation that 2-15 holds a certificate of authority issued by the commissioner under 2-16 Article 21.52F of this code. 2-17 (b) This article does not apply to: 2-18 (1) a plan that provides coverage: 2-19 (A) only for a specified disease or other 2-20 limited benefit, other than a pharmacy or prescription drug 2-21 benefit; 2-22 (B) only for accidental death or dismemberment; 2-23 (C) for wages or payments in lieu of wages for a 2-24 period during which an employee is absent from work because of 2-25 sickness or injury; 2-26 (D) as a supplement to liability insurance; 2-27 (E) for credit insurance; 3-1 (F) only for dental or vision care; 3-2 (G) only for hospital expenses; or 3-3 (H) only for indemnity for hospital confinement; 3-4 (2) a small employer health benefit plan written under 3-5 Chapter 26 of this code; 3-6 (3) a Medicare supplemental policy as defined by 3-7 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 3-8 (4) workers' compensation insurance coverage; 3-9 (5) medical payment insurance coverage issued as part 3-10 of a motor vehicle insurance policy; or 3-11 (6) a long-term care policy, including a nursing home 3-12 fixed indemnity policy, unless the commissioner determines that the 3-13 policy provides benefit coverage so comprehensive that the policy 3-14 is a health benefit plan as described by Subsection (a) of this 3-15 section. 3-16 Sec. 3. MINIMUM NUMBER OF PHARMACIES REQUIRED IN NETWORK. 3-17 (a) This section applies only to a health benefit plan that: 3-18 (1) provides pharmacy or prescription drug benefits; 3-19 and 3-20 (2) requires or encourages enrollees in the plan to 3-21 use a network pharmacy to obtain pharmaceutical services or 3-22 prescription drugs for which benefits are provided under the plan. 3-23 (b) The issuer of a health benefit plan shall maintain at 3-24 least two network pharmacies in each municipality in the state in 3-25 which an enrollee in the plan resides. 3-26 (c) If there are less than two pharmacies in a municipality 3-27 in which an enrollee in the plan resides, the issuer of the health 4-1 benefit plan shall comply with rules adopted by the commissioner 4-2 under this article to ensure adequate access to benefits for 4-3 pharmaceutical services and prescription drugs. 4-4 (d) Compliance with this article does not affect the duty of 4-5 an issuer of a health benefit plan to provide benefits for 4-6 pharmaceutical services or prescription drugs through an adequate 4-7 number of pharmacies. 4-8 Sec. 4. RULES. The commissioner shall adopt rules to 4-9 implement this article. 4-10 SECTION 2. This Act takes effect September 1, 1999, and 4-11 applies only to a health benefit plan delivered, issued for 4-12 delivery, or renewed on or after January 1, 2000. A health benefit 4-13 plan that is delivered before January 1, 2000, is governed by the 4-14 law as it existed immediately before the effective date of this 4-15 Act, and that law is continued in effect for that purpose. 4-16 SECTION 3. The importance of this legislation and the 4-17 crowded condition of the calendars in both houses create an 4-18 emergency and an imperative public necessity that the 4-19 constitutional rule requiring bills to be read on three several 4-20 days in each house be suspended, and this rule is hereby suspended.