By Madla S.B. No. 804
77R6976 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to continuation of benefits for prescription drugs under
1-3 certain group health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 4, Article 21.52J, Insurance Code, is
1-6 amended by amending Subsection (a) and adding Subsection (c) to
1-7 read as follows:
1-8 (a) Except as provided by Subsection (c), a [A] group health
1-9 benefit plan that offers prescription drug benefits shall make a
1-10 prescription drug that was prescribed for an enrollee during the
1-11 plan year [approved or covered for a medical condition or mental
1-12 illness] available to the [each] enrollee at the contracted benefit
1-13 level until the enrollee's plan renewal date, regardless of whether
1-14 the prescribed drug has been removed from the health benefit plan's
1-15 drug formulary.
1-16 (c) Subsection (a) of this section does not require a group
1-17 health benefit plan to continue to provide prescription drug
1-18 benefits for a prescription drug if:
1-19 (1) the United States Food and Drug Administration
1-20 prohibits:
1-21 (A) the sale or use of the drug; or
1-22 (B) the use of the drug as prescribed to an
1-23 enrollee; or
1-24 (2) the United States Food and Drug Administration or
2-1 the drug's manufacturer identifies a side effect, adverse reaction,
2-2 or other health risk associated with the drug that:
2-3 (A) was unknown at the time the drug was
2-4 prescribed to the enrollee; or
2-5 (B) is substantially more severe, as determined
2-6 under rules adopted by the commissioner, than was believed at the
2-7 time the drug was prescribed to the enrollee.
2-8 SECTION 2. This Act takes effect September 1, 2001, and
2-9 applies only to a group health benefit plan that is delivered,
2-10 issued for delivery, or renewed on or after January 1, 2002. A
2-11 group health benefit plan that is delivered, issued for delivery,
2-12 or renewed before January 1, 2002, is governed by the law as it
2-13 existed immediately before the effective date of this Act, and that
2-14 law is continued in effect for this purpose.