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.