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S.B. No. 1173
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. Section 1551.205, Insurance Code, as effective
June 1, 2003, is amended to read as follows:
Sec. 1551.205. LIMITATIONS. The board of trustees may not
contract for or provide a coverage plan that:
(1) excludes or limits coverage or services for
acquired immune deficiency syndrome, as defined by the Centers for
Disease Control and Prevention of the United States Public Health
Service, or human immunodeficiency virus infection; [or]
(2) provides coverage for serious mental illness that
is less extensive than the coverage provided for any physical
illness; or
(3) may provide coverage for prescription drugs to
assist in stopping smoking at a lower benefit level than is provided
for other prescription drugs.
SECTION 2. 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 group benefits 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 shall 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 3. 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 group program through implementation
of the prior authorization requirement of this section. A report
must cover the previous six-month period.
SECTION 4. 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 5. The initial reports required by Subsection (c),
Section 1551.218, and Subsection (c), Section 1575.161, Insurance
Code, and Subsection (c), Article 3.50-7A, Insurance Code, as added
by this Act, are due September 1, 2005.
SECTION 6. Section 1551.205(3), Insurance Code, as added by
this Act applies only to coverage contracted for or provided by the
board of trustees established under Chapter 815, Government Code,
to administer the Employees Retirement System of Texas on or after
September 1, 2004. Coverage contracted for or provided by the board
of trustees before September 1, 2004, is governed by the law in
effect immediately before the effective date of this Act, and that
law is continued in effect for that purpose.
SECTION 7. 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.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1173 passed the Senate on
May 13, 2003, by the following vote: Yeas 31, Nays 0; and that the
Senate concurred in House amendments on May 31, 2003, by the
following vote: Yeas 30, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1173 passed the House, with
amendments, on May 28, 2003, by the following vote: Yeas 138,
Nays 0, two present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor