85R5843 PMO-D
  By: Seliger S.B. No. 895
  relating to the transparency of certain information related to
  prescription drug coverage provided by certain health benefit
         SECTION 1.  Chapter 1369, Insurance Code, is amended by
  adding Subchapter B-1 to read as follows:
         Sec. 1369.076.  DEFINITIONS. In this subchapter, terms
  defined by Subchapter B have the meanings assigned by that
         Sec. 1369.077.  APPLICABILITY OF SUBCHAPTER. This
  subchapter applies only to a health benefit plan that:
               (1)  provides prescription drug coverage under an
  individual health benefit plan to which Subchapter B applies; and
               (2)  uses one or more drug formularies to specify the
  prescription drugs covered under the plan.
         SECTION 2.  Sections 1369.0542 through 1369.0544, Insurance
  Code, are transferred to Subchapter B-1, Insurance Code,
  redesignated as Sections 1369.078 through 1369.080, and amended to
  read as follows:
         Sec. 1369.078 [1369.0542].  FORMULARY INFORMATION ON
  INTERNET WEBSITE. (a)  A health benefit plan issuer shall display
  on a public Internet website maintained by the issuer formulary
  information for each of the issuer's individual health benefit
  plans as required by the commissioner by rule.
         (b)  A direct electronic link to the formulary information
  must be displayed in a conspicuous manner in the electronic summary
  of benefits and coverage of each individual health benefit plan
  issued by the health benefit plan issuer on the health benefit plan
  issuer's Internet website.  The information must be publicly
  accessible to enrollees, prospective enrollees, and others without
  necessity of providing a password, a user name, or personally
  identifiable information.
         Sec. 1369.079 [1369.0543].  FORMULARY DISCLOSURE
  REQUIREMENTS. (a)  The commissioner shall develop and adopt by rule
  requirements to promote consistency and clarity in the disclosure
  of formularies to facilitate comparison shopping among individual 
  health benefit plans.
         (b)  The requirements adopted under Subsection (a) must
  apply to each prescription drug:
               (1)  included in a formulary and dispensed in a network
  pharmacy; or
               (2)  covered under an individual [a] health benefit
  plan and typically administered by a physician or health care
         (c)  The formulary disclosures must:
               (1)  be electronically searchable by drug name;
               (2)  include for each drug the information required by
  Subsection (d) in the order listed in that subsection; and
               (3)  indicate each formulary that applies to each
  individual health benefit plan issued by the issuer.
         (d)  The formulary disclosures must include for each drug:
               (1)  the cost-sharing amount for each drug, including
  as applicable:
                     (A)  the dollar amount of a copayment; or
                     (B)  for a drug subject to coinsurance:
                           (i)  an enrollee's cost-sharing amount
  stated in dollars; or
                           (ii)  a cost-sharing range, denoted as
                                 (a)  under $100 - $;
                                 (b)  $100-$250 - $$;
                                 (c)  $251-$500 - $$$;
                                 (d)  $501-$1,000 - $$$$; or
                                 (e)  over $1,000 - $$$$$;
               (2)  a disclosure of prior authorization, step therapy,
  or other protocol requirements for each drug;
               (3)  if the individual health benefit plan uses a
  tier-based formulary, the specific tier for each drug listed in the
               (4)  a description of how prescription drugs will
  specifically be included in or excluded from the deductible,
  including a description of out-of-pocket costs for a prescription
  drug that may not apply to the deductible;
               (5)  identification of preferred formulary drugs; and
               (6)  an explanation of coverage of each formulary drug.
         (e)  The commissioner by rule may allow an alternative method
  of making disclosures required under Subsection (d)(1) relating to
  cost-sharing through a web-based tool that must:
               (1)  be publicly accessible to enrollees, prospective
  enrollees, and others without necessity of providing a password, a
  user name, or personally identifiable information;
               (2)  allow consumers to electronically search
  formulary information by the name under which the individual health
  benefit plan is marketed; and
               (3)  be accessible through a direct link that is
  displayed on each page of the formulary disclosure that lists each
  drug as required under Subsection (c).
         Sec. 1369.080 [1369.0544].  FORMULARY INFORMATION PROVIDED
  BY TOLL-FREE TELEPHONE NUMBER.  In addition to providing the
  information described by Section 1369.079(d)(1) in the manner
  required by Section 1369.079 [1369.0543(d)(1)], a health benefit
  plan issuer may make the information available to enrollees,
  prospective enrollees, and others through a toll-free telephone
  number that operates at least during normal business hours.
         SECTION 3.  The changes in law made by this Act apply only to
  a health benefit plan that is delivered, issued for delivery, or
  renewed on or after September 1, 2017. A health benefit plan
  delivered, issued for delivery, or renewed before September 1,
  2017, is governed by the law as it existed immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         SECTION 4.  This Act takes effect September 1, 2017.