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A BILL TO BE ENTITLED
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AN ACT
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relating to certain modifications of 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 B, Chapter 1369, Insurance Code, is |
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amended by adding Section 1369.0541 to read as follows: |
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Sec. 1369.0541. MODIFICATION OF DRUG COVERAGE UNDER PLAN. |
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(a) In addition to applying to a group health benefit plan to which |
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this subchapter applies, this section applies to an individual |
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health benefit plan, as defined by Section 544.501. |
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(b) Notwithstanding Section 1369.053, this section applies |
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to a small employer health benefit plan written under Chapter 1501. |
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(c) A group or individual health benefit plan issuer may |
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modify drug coverage provided under a health benefit plan if: |
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(1) the modification occurs at the time of coverage |
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renewal; |
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(2) the modification is effective uniformly among all |
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group health benefit plan sponsors covered by identical or |
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substantially identical health benefit plans or all individuals |
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covered by identical or substantially identical individual health |
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benefit plans, as applicable; and |
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(3) not later than the 60th day before the date the |
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modification is effective, the issuer provides written notice of |
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the modification to the commissioner, each affected group health |
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benefit plan sponsor, each affected enrollee in an affected group |
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health benefit plan, and each affected individual health benefit |
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plan holder. |
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(d) Modifications affecting drug coverage that require |
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notice under Subsection (c) include: |
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(1) removing a drug from a formulary; |
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(2) adding a requirement that an enrollee receive |
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prior authorization for a drug; |
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(3) imposing or altering a quantity limit for a drug; |
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(4) imposing a step-therapy restriction for a drug; |
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and |
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(5) moving a drug to a higher cost-sharing tier unless |
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a generic drug alternative to the drug is available. |
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(e) A group or individual health benefit plan issuer may |
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elect to offer an enrollee in the plan the option of receiving |
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notifications required by this section by e-mail. |
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SECTION 2. Section 1501.108(d), Insurance Code, is amended |
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to read as follows: |
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(d) Notwithstanding Subsection (a), a small or large |
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employer health benefit plan issuer may modify a small or large |
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employer health benefit plan in accordance with Section 1369.0541 |
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or if: |
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(1) the modification occurs at the time of coverage |
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renewal; |
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(2) the modification is effective uniformly among all |
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small or large employers covered by that health benefit plan; and |
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(3) the issuer notifies the commissioner and each |
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affected covered small or large employer of the modification not |
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later than the 60th day before the date the modification is |
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effective. |
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SECTION 3. This Act takes effect September 1, 2011. |