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.