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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.