By: Talarico H.B. No. 40

A BILL TO BE ENTITLED

AN ACT

relating to a cap on the monthly price of insulin and insulin supplies.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1358, Insurance Code, is amended by adding Section 1358.058 to read as follows:

Sec. 1358.058. COST SHARING IN PRESCRIPTION INSULIN DRUGS - LIMITS CONFIDENTIALITY OF REBATE INFORMATION - DEFINITION -RULES.

(1) As used in this section, unless the context other requires, "prescription insulin drug" means a prescription drug, as defined in section 1358.051, that contains insulin and is used to treat diabetes.

(2) a carrier that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the carrier offers shall cap the total amount that a covered person is required to pay for a covered prescription insulin drug at an amount not to exceed one hundred dollars per thirty-day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person's prescription.

(3) nothing in this section prevents a carrier from reducing a covered person's cost sharing by an amount greater than the amount specified in subsection (2) of this section.

(4) This section applies to health coverage plans offered by the Employees Retirement System of Texas and the Teacher Retirement System of Texas.

(5) the commissioner may use any of the commissioner's enforcement powers to obtain a carrier's compliance with this section.

(6) the commissioner may promulgate rules as necessary to implement and administer this section and to align with federal requirements.

SECTION 2. Chapter 1358, Insurance Code, is amended by adding Section 1358.059 to read as follows:

Sec. 1358.059. INVESTIGATION AND REPORTING OF PRESCRIPTION INSULIN DRUG PRICING. (a) The Department of Health and Human Services shall investigate and report on the pricing of prescription insulin drugs

(1) made available to Texas consumers to ensure adequate consumer protections in pricing of prescription insulin drugs and whether additional consumer protections are needed.

(2) (a) as part of the investigation by the department, the department shall gather, compile, and analyze information concerning the organization, business practices, pricing information, data, reports, or other information that the department finds necessary to fulfill the requirements of this section from companies engaged in the manufacture or sale of prescription insulin drugs. The department shall also consider any publicly available information related to drug pricing.

(b) if necessary to fulfill the reporting requirements of this section, the attorney general may issue a civil investigative demand requiring a state department; carrier; pharmacy benefit management firm; or manufacturer of prescription insulin drugs that are made available in Texas, to furnish material, answers, data, or other relevant information.

(3) a person or business shall not be compelled to provide trade secrets.

(4) by September 1, 2022, the department shall issue and make available to the public a report detailing its findings from the investigation conducted pursuant to this section. The department shall present the report to the Governor, the Lieutenant Governor, the Speaker of the House, and the Senate Committee on Business and Commerce and the House Committee on Insurance or their successor committees. The report must include:

(a) a summary of insulin pricing practices and variables that contribute to pricing of health coverage plans;

(b) public policy recommendations to control and prevent overpricing of prescription insulin drugs made available to Texas consumers;

(c) any recommendations to improve consumer protections, to prevent deceptive sales practices related to the sale of prescription insulin drugs, including the pricing of those drugs; and

(d) any other information the department finds necessary.

(5) this section is repealed, effective December 1, 2022.

SECTION 3. This Act applies only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2022. A health benefit plan that is delivered, issued for delivery, or renewed before January 1, 2022, 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 7. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2021.