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A BILL TO BE ENTITLED
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AN ACT
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relating to insurance coverage of prescription drugs provided under |
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a health benefit plan. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 1369, Insurance Code, is |
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amended by adding Section 1369.0041 to read as follows: |
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Sec. 1369.0041. CHANGES IN PRESCRIPTION DRUG COVERAGE. (a) |
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In this section, "drug formulary," "enrollee," and "prescription |
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drug" have the meanings assigned by Section 1369.051. |
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(b) Except as provided by Subsection (d), an issuer of a |
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health benefit plan that covers prescription drugs may not limit, |
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reduce, or deny coverage to an enrollee for a prescription drug if, |
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at the time the limitation, reduction, or denial of coverage would |
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otherwise take place, the enrollee is using the prescription drug |
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and is entitled to coverage under the plan for the drug. |
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(c) For the purposes of this section, a limitation, |
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reduction, or denial of coverage includes: |
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(1) the removal of a prescription drug from a drug |
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formulary; |
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(2) the imposition of a new prior authorization or |
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other use-management requirement; |
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(3) the placement of the drug on a formulary tier that |
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increases the patient's cost-sharing obligation for the drug; or |
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(4) an increase by any other method of the patient's |
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cost-sharing obligation for the drug. |
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(d) This section does not prohibit a health benefit plan |
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issuer from: |
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(1) making a uniform change in a plan's benefit design |
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that applies to all covered prescription drugs; or |
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(2) increasing cost-sharing obligations for a |
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prescription drug as a result of a percentage-based coinsurance |
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payment the dollar amount of which increases as a result of an |
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increase in the underlying price of the drug. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2010. A health benefit plan delivered, |
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issued for delivery, or renewed before January 1, 2010, is governed |
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by the law in effect immediately before the effective date of this |
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Act, and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2009. |