BILL ANALYSIS |
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C.S.H.B. 3025 |
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By: Farney |
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Insurance |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Many Americans live with at least one chronic disease, such as high blood pressure, diabetes, high cholesterol, or heart disease. Medication is often a primary source of medical treatment for these conditions and patients with multiple chronic conditions can have difficulty juggling the refills on their medication. This can lead to missed doses and interrupted treatment plans, which can result in avoidable and costly health complications, worsening of disease progression, and increased emergency room visits and hospital stays. Concerned parties observe that under a medicine synchronization plan, the patient, health care insurer, and pharmacist work together to determine which of the patient's prescriptions should be synchronized, allowing for the alignment of refill dates for prescription drugs. C.S.H.B. 3025 seeks to encourage the use of prescription drug synchronization plans.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
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ANALYSIS
C.S.H.B. 3025 amends the Insurance Code to require a health benefit plan that provides benefits for prescription drugs to prorate any cost-sharing amount charged for a prescription drug dispensed in a quantity that is less than a 30 days' supply if the pharmacy or the covered person's prescribing physician or health care provider notifies the health benefit plan that the quantity dispensed is to synchronize the dates that the pharmacy dispenses the covered person's prescription drugs and the synchronization is in the covered person's best interest and the covered person agrees to the synchronization. The bill requires the proration to be based on the number of days' supply of the drug actually dispensed. The bill prohibits a health benefit plan that prorates a cost-sharing amount from prorating the fee paid to the pharmacy for dispensing the drug for which the cost-sharing amount was prorated.
C.S.H.B. 3025 requires a health benefit plan to establish a process through which the health benefit plan, the covered person, the prescribing physician or health care provider, and a pharmacist may jointly approve a medication synchronization plan for medication to treat a covered person's chronic illness. The bill requires a health benefit plan to provide coverage for a medication dispensed in accordance with the dates established in the medication synchronization plan and to establish a process that allows a pharmacist or pharmacy to override the health benefit plan's denial of coverage for a medication to treat a person's chronic illness. The bill requires a health benefit plan to allow a pharmacist or pharmacy to override the health benefit plan's denial of coverage through such a process and requires the health benefit plan to provide coverage for the medication if the prescription for the medication is being refilled in accordance with the medication synchronization plan and the reason for the denial is that the prescription is being refilled before the date established by the plan's general prescription refill guidelines.
C.S.H.B. 3025 applies to health benefit plans that provide benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness and that are offered by specified insurers; group coverage made available by a school district; health benefit plan coverage provided to state employees, public school employees, employees of The University of Texas System and The Texas A&M University System under the applicable programs; coverage under certain small employer health benefit plans; and to a consumer choice of benefits plan. The bill requires, to the extent allowed by federal law, the children's health plan program (CHIP), the health benefits plan for children for certain qualified aliens, the state Medicaid program, and a Medicaid managed care organization that contracts with the Health and Human Services Commission to provide health care services to Medicaid recipients to provide the coverage required under the bill's provisions. The bill applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2016.
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EFFECTIVE DATE
September 1, 2015.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 3025 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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