BILL ANALYSIS |
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C.S.H.B. 1296 |
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By: Frullo |
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Insurance |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Interested parties note that patients with multiple chronic conditions can have difficulty managing medication refills, which may lead to missed doses and interrupted treatment plans, avoidable and costly health complications, worsening of disease progression, and increased emergency room visits and hospital stays. C.S.H.B. 1296 seeks to avoid these negative effects by encouraging 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. 1296 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 partial supply of a prescription drug if the pharmacy or the enrollee'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 enrollee's prescription drugs and that the synchronization is in the enrollee's best interest and if the enrollee agrees to the synchronization. The bill specifies the types of medications with respect to which the bill's provisions apply and 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. 1296 requires a health benefit plan to establish a process through which the health benefit plan, the enrollee, the prescribing physician or health care provider, and a pharmacist may jointly approve a medication synchronization plan for medication to treat the enrollee'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 the enrollee'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. 1296 establishes the applicability of its provisions and requires, to the extent allowed by federal law, the child health plan program and the state Medicaid program, including the Medicaid managed care program, 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, 2018.
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EFFECTIVE DATE
September 1, 2017.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 1296 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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