78R2884 DLF-F
By: Deshotel H.B. No. 1955
A BILL TO BE ENTITLED
AN ACT
relating to prescription drug benefits under certain health benefit
plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
amended by adding Article 21.52B-1 to read as follows:
Art. 21.52B-1. DELIVERY OF PRESCRIPTION DRUGS BY MAIL
ORDER; ALTERNATIVE REQUIRED
Sec. 1. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this
article, "health benefit plan" means a plan that provides benefits
for medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842 of this code;
(3) a fraternal benefit society operating under
Chapter 885 of this code;
(4) a stipulated premium insurance company operating
under Chapter 884 of this code;
(5) an exchange operating under Chapter 942 of this
code;
(6) a health maintenance organization operating under
Chapter 843 of this code;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846 of this code; or
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844 of this code.
(b) "Health benefit plan" does not include:
(1) a plan that provides coverage only:
(A) for benefits for a specified disease or for
another limited benefit other than for cancer;
(B) for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) for dental or vision care; or
(G) for indemnity for hospital confinement;
(2) a small employer health benefit plan offered in
accordance with Chapter 26 of this code;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Subsection (a) of this section.
Sec. 2. DELIVERY BY MAIL ORDER. For purposes of this
article, a prescription drug is obtained by mail order if it is
delivered to an enrollee by the United States Postal Service or a
commercial delivery service and not provided to the enrollee in an
over-the-counter transaction in a pharmacy.
Sec. 3. PROHIBITION. A health benefit plan that provides
benefits for prescription drugs may not condition the benefits by
requiring enrollees to obtain the drugs by mail order.
Sec. 4. AVAILABILITY OF PRESCRIPTION DRUGS. (a) A health
benefit plan that provides benefits for prescription drugs must
provide the benefit for a prescription drug that is not obtained by
mail order:
(1) for each prescription drug that may be obtained by
mail order under the plan; and
(2) under the same circumstances as a prescription
drug that may be obtained by mail order under the plan.
(b) The health benefit plan may not impose any deductible,
copayment, coinsurance, or other cost-sharing obligation for a
prescription drug that is not obtained by mail order unless a
similar cost-sharing obligation is imposed for a prescription drug
obtained by mail order under the plan.
(c) Except as provided by Subsection (d) of this section,
the health benefit plan must provide the same dollar amount of
payment for a prescription drug that is not obtained by mail order
as is provided for a prescription drug obtained by mail order under
the plan.
(d) A health benefit plan that does not comply with
Subsection (c) of this section may not impose any deductible,
copayment, coinsurance, or other cost-sharing obligation for a
prescription drug that is not obtained by mail order that exceeds
the amount of the cost-sharing obligation imposed for a
prescription drug obtained by mail order under the plan.
Sec. 5. UNFAIR ACT IN THE BUSINESS OF INSURANCE. An issuer
of a health benefit plan that violates this article commits an
unfair act in the business of insurance for purposes of Article
21.21 of this code.
SECTION 2. This Act takes effect September 1, 2003, and
applies only to a health benefit plan that is delivered, issued for
delivery, or renewed on or after January 1, 2004. A plan that is
delivered, issued for delivery, or renewed before January 1, 2004,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.