By Bernsen                                            S.B. No. 1687
         76R6096 DLF-F                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to the availability of prescription drugs from certain
 1-3     pharmacies under a health care plan offered by a health maintenance
 1-4     organization.
 1-5           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-6           SECTION 1.  The Texas Health Maintenance Organization Act
 1-7     (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
 1-8     Section 40 to read as follows:
 1-9           Sec. 40.  USE OF OUT-OF-NETWORK PHARMACIES.  (a)  In this
1-10     section:
1-11                 (1)  "Network pharmacy" means a pharmacy that, under
1-12     contract to a health maintenance organization, provides
1-13     prescription drugs to  enrollees in a health care plan.
1-14                 (2)  "Out-of-network pharmacy" means a pharmacy that is
1-15     not under contract to a health maintenance organization for a
1-16     health care plan.
1-17           (b)  An enrollee may select an out-of-network pharmacy to
1-18     provide prescription drugs to the enrollee.
1-19           (c)  The health maintenance organization shall pay the
1-20     out-of-network pharmacy an amount equal to the amount the health
1-21     maintenance organization would pay to a network pharmacy for the
1-22     same prescription drug. Notwithstanding any other law, an enrollee
1-23     who selects an out-of-network pharmacy under Subsection (b) of this
1-24     section is responsible for any amount charged for the prescription
 2-1     drug by that pharmacy that exceeds the amount paid by the health
 2-2     maintenance organization.
 2-3           (d)  This section does not affect the duty of a health
 2-4     maintenance organization to provide prescription drug benefits
 2-5     through an  adequate number of network pharmacies.
 2-6           (e)  This section does not require a health maintenance
 2-7     organization to provide benefits for a prescription drug:
 2-8                 (1)  that is not included in the  health maintenance
 2-9     organization's prescription drug formulary or for which benefits
2-10     would not otherwise be provided under the evidence of coverage; or
2-11                 (2)  without prior authorization or precertification
2-12     from the health care plan, if the preauthorization or
2-13     precertification is required under the health care plan.
2-14           (f)  The department shall adopt rules to implement this
2-15     section.
2-16           SECTION 2.  This Act takes effect September 1, 1999, and
2-17     applies only to an evidence of coverage for a health care plan that
2-18     is delivered, issued for delivery, or renewed on or after January
2-19     1, 2000.  An evidence of coverage for a health care plan that is
2-20     delivered, issued for delivery, or renewed before January 1, 2000,
2-21     is governed by the law as it existed immediately before the
2-22     effective date of this Act, and that law is continued in effect for
2-23     that purpose.
2-24           SECTION 3.  The importance of this legislation and the
2-25     crowded condition of the calendars in both houses create an
2-26     emergency and an imperative public necessity that the
2-27     constitutional rule requiring bills to be read on three several
 3-1     days in each house be suspended, and this rule is hereby suspended.