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By: Delisi, Menendez, Harper-Brown H.B. No. 1744
A BILL TO BE ENTITLED
AN ACT
relating to prescription drug benefits under the group health
benefit programs for certain governmental employees and retired
employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 1551, Insurance Code, as
effective June 1, 2003, is amended by adding Sections 1551.218 and
1551.219 to read as follows:
Sec. 1551.218. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a)
In this section, "drug formulary" means a list of drugs preferred
for use and eligible for coverage under a health benefit plan.
(b) A health benefit plan provided under this chapter that
uses a drug formulary in providing a prescription drug benefit must
require prior authorization for coverage of the following
categories of prescribed drugs if the specific drug prescribed is
not included in the formulary:
(1) a gastrointestinal drug;
(2) a cholesterol-lowering drug;
(3) an anti-inflammatory drug;
(4) an antihistamine drug; and
(5) an antidepressant drug.
(c) Every six months the board of trustees shall submit to
the comptroller and Legislative Budget Board a report regarding any
cost savings achieved in the program through implementation of the
prior authorization requirement of this section. A report must
cover the previous six-month period.
Sec. 1551.219. MAIL ORDER REQUIREMENT FOR PRESCRIPTION DRUG
COVERAGE PROHIBITED. The board of trustees or a health benefit plan
under this chapter that provides benefits for prescription drugs
may not require a participant in the group benefits program to
purchase a prescription drug through a mail order program. The
board or health benefit plan may require that a participant who
chooses to obtain a prescription drug through a retail pharmacy or
other method other than by mail order pay a deductible, copayment,
coinsurance, or other cost-sharing obligation to cover the
additional cost of obtaining a prescription drug through that
method rather than by mail order.
SECTION 2. Subchapter D, Chapter 1575, Insurance Code, as
effective June 1, 2003, is amended by adding Section 1575.161 to
read as follows:
Sec. 1575.161. PRIOR AUTHORIZATION FOR CERTAIN DRUGS. (a)
In this section, "drug formulary" means a list of drugs preferred
for use and eligible for coverage under a health benefit plan.
(b) A health benefit plan provided under this chapter that
uses a drug formulary in providing a prescription drug benefit must
require prior authorization for coverage of the following
categories of prescribed drugs if the specific drug prescribed is
not included in the formulary:
(1) a gastrointestinal drug;
(2) a cholesterol-lowering drug;
(3) an anti-inflammatory drug;
(4) an antihistamine; and
(5) an antidepressant drug.
(c) Every six months the board of trustees shall submit to
the comptroller and Legislative Budget Board a report regarding any
cost savings achieved in the program through implementation of the
prior authorization requirement of this section. A report must
cover the previous six-month period.
SECTION 3. Subchapter E, Chapter 3, Insurance Code, is
amended by adding Article 3.50-7A to read as follows:
Art. 3.50-7A. PRIOR AUTHORIZATION FOR CERTAIN DRUGS
PROVIDED UNDER TEXAS SCHOOL EMPLOYEES UNIFORM GROUP COVERAGE
PROGRAM. (a) In this article, "drug formulary" means a list of
drugs preferred for use and eligible for coverage by a health
coverage plan.
(b) A health coverage plan provided under the uniform group
coverage program established under Article 3.50-7 of this code that
uses a drug formulary in providing a prescription drug benefit must
require prior authorization for coverage of the following
categories of prescribed drugs if the specific drug prescribed is
not included in the formulary:
(1) a gastrointestinal drug;
(2) a cholesterol-lowering drug;
(3) an anti-inflammatory drug;
(4) an antihistamine drug; and
(5) an antidepressant drug.
(c) Every six months the Teacher Retirement System of Texas
shall submit to the comptroller and Legislative Budget Board a
report regarding any cost savings achieved in the uniform group
coverage program through implementation of the prior authorization
requirement of this article. A report must cover the previous
six-month period.
SECTION 4. The initial reports required by Sections
1551.218(c) and 1575.161(c), Insurance Code, and Subsection (c),
Article 3.50-7A, Insurance Code, as added by this Act, are due
September 1, 2005.
SECTION 5. This Act takes effect September 1, 2003, and
applies to health benefit plans provided under Chapters 1551 and
1575, Insurance Code, as effective June 1, 2003, and health
coverage plans subject to Article 3.50-7A, Insurance Code, as added
by this Act, beginning with the 2004-2005 plan year.