Amend CSSB 680 (senate committee report) as follows:
(1) In SECTION 1 of the bill, in amended Section 1369.051(1), Insurance Code (page 1, line 28), strike "physicians and, when appropriate" and substitute "a multidisciplinary panel of experts composed of physicians and, as necessary".
(2) In SECTION 1 of the bill, in added Section 1369.051(1-a), Insurance Code (page 1, line 34), before "practice", insert "clinical".
(3) In SECTION 2 of the bill, in added Section 1369.0545(a)(1), Insurance Code (page 2, line 3), strike "be based on" and substitute "consider".
(4) In SECTION 2 of the bill, in added Section 1369.0545(a)(2), Insurance Code (page 2, line 24), strike "including" and substitute "which may include".
(5) In SECTION 2 of the bill, strike added Section 1369.0545(c), Insurance Code (page 2, lines 42-50), and substitute the following:
(c) Subsection (b) does not apply to a panel or committee of experts, including a pharmacy and therapeutics committee, established by a health benefit plan issuer or a pharmacy benefit manager that advises the health benefit plan issuer or pharmacy benefit manager regarding drugs or formularies.
(6) In SECTION 2 of the bill, strike added Section 1369.0546(b), Insurance Code (page 2, lines 57-61), and substitute the following:
(b) A prescribing provider on behalf of a patient may submit to the patient's health benefit plan issuer a written request for an exception to a step therapy protocol required by the patient's health benefit plan. The provider shall submit the request on the standard form prescribed by the commissioner under Section 1369.304.
(7) In SECTION 2 of the bill, strike added Section 1369.0546(c)(4), Insurance Code (page 3, lines 21-24), and substitute the following:
(4)(A) the drug that is subject to the step therapy protocol was prescribed for the patient's condition;
(B) the patient:
(i) received benefits for the drug under the health benefit plan currently in force or a previous health benefit plan; and
(ii) is stable on the drug; and
(C) the change in the patient's prescription drug regimen required by the step therapy protocol is expected to be ineffective or cause harm to the patient based on the known clinical characteristics of the patient and the known characteristics of the required prescription drug regimen.