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A BILL TO BE ENTITLED
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AN ACT
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relating to the transparency of certain information related to |
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prescription drug coverage provided by certain health benefit |
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plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1369, Insurance Code, is amended by |
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adding Subchapter B-1 to read as follows: |
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SUBCHAPTER B-1. TRANSPARENCY REQUIREMENTS FOR CERTAIN INDIVIDUAL |
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HEALTH BENEFIT PLANS |
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Sec. 1369.076. DEFINITIONS. In this subchapter, terms |
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defined by Subchapter B have the meanings assigned by that |
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subchapter. |
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Sec. 1369.077. APPLICABILITY OF SUBCHAPTER. This |
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subchapter applies only to a health benefit plan that: |
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(1) provides prescription drug coverage under an |
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individual health benefit plan to which Subchapter B applies; and |
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(2) uses one or more drug formularies to specify the |
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prescription drugs covered under the plan. |
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SECTION 2. Sections 1369.0542 through 1369.0544, Insurance |
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Code, are transferred to Subchapter B-1, Insurance Code, |
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redesignated as Sections 1369.078 through 1369.080, and amended to |
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read as follows: |
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Sec. 1369.078 [1369.0542]. FORMULARY INFORMATION ON |
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INTERNET WEBSITE. (a) A health benefit plan issuer shall display |
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on a public Internet website maintained by the issuer formulary |
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information for each of the issuer's individual health benefit |
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plans as required by the commissioner by rule. |
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(b) A direct electronic link to the formulary information |
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must be displayed in a conspicuous manner in the electronic summary |
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of benefits and coverage of each individual health benefit plan |
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issued by the health benefit plan issuer on the health benefit plan |
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issuer's Internet website. The information must be publicly |
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accessible to enrollees, prospective enrollees, and others without |
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necessity of providing a password, a user name, or personally |
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identifiable information. |
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Sec. 1369.079 [1369.0543]. FORMULARY DISCLOSURE |
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REQUIREMENTS. (a) The commissioner shall develop and adopt by rule |
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requirements to promote consistency and clarity in the disclosure |
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of formularies to facilitate comparison shopping among individual |
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health benefit plans. |
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(b) The requirements adopted under Subsection (a) must |
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apply to each prescription drug: |
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(1) included in a formulary and dispensed in a network |
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pharmacy; or |
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(2) covered under an individual [a] health benefit |
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plan and typically administered by a physician or health care |
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provider. |
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(c) The formulary disclosures must: |
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(1) be electronically searchable by drug name; |
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(2) include for each drug the information required by |
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Subsection (d) in the order listed in that subsection; and |
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(3) indicate each formulary that applies to each |
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individual health benefit plan issued by the issuer. |
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(d) The formulary disclosures must include for each drug: |
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(1) the cost-sharing amount for each drug, including |
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as applicable: |
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(A) the dollar amount of a copayment; or |
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(B) for a drug subject to coinsurance: |
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(i) an enrollee's cost-sharing amount |
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stated in dollars; or |
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(ii) a cost-sharing range, denoted as |
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follows: |
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(a) under $100 - $; |
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(b) $100-$250 - $$; |
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(c) $251-$500 - $$$; |
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(d) $501-$1,000 - $$$$; or |
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(e) over $1,000 - $$$$$; |
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(2) a disclosure of prior authorization, step therapy, |
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or other protocol requirements for each drug; |
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(3) if the individual health benefit plan uses a |
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tier-based formulary, the specific tier for each drug listed in the |
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formulary; |
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(4) a description of how prescription drugs will |
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specifically be included in or excluded from the deductible, |
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including a description of out-of-pocket costs for a prescription |
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drug that may not apply to the deductible; |
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(5) identification of preferred formulary drugs; and |
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(6) an explanation of coverage of each formulary drug. |
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(e) The commissioner by rule may allow an alternative method |
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of making disclosures required under Subsection (d)(1) relating to |
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cost-sharing through a web-based tool that must: |
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(1) be publicly accessible to enrollees, prospective |
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enrollees, and others without necessity of providing a password, a |
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user name, or personally identifiable information; |
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(2) allow consumers to electronically search |
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formulary information by the name under which the individual health |
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benefit plan is marketed; and |
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(3) be accessible through a direct link that is |
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displayed on each page of the formulary disclosure that lists each |
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drug as required under Subsection (c). |
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Sec. 1369.080 [1369.0544]. FORMULARY INFORMATION PROVIDED |
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BY TOLL-FREE TELEPHONE NUMBER. In addition to providing the |
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information described by Section 1369.079(d)(1) in the manner |
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required by Section 1369.079 [1369.0543(d)(1)], a health benefit |
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plan issuer may make the information available to enrollees, |
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prospective enrollees, and others through a toll-free telephone |
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number that operates at least during normal business hours. |
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SECTION 3. The changes in law made by this Act apply only to |
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a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after September 1, 2017. A health benefit plan |
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delivered, issued for delivery, or renewed before September 1, |
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2017, is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2017. |