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  H.B. No. 999
 
 
 
 
AN ACT
  relating to the effect of certain reductions in a health benefit
  plan enrollee's out-of-pocket expenses for certain prescription
  drugs on enrollee cost-sharing requirements.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Subchapter B, Chapter 1369,
  Insurance Code, is amended to read as follows:
  SUBCHAPTER B. REQUIREMENTS AFFECTING COVERAGE OF SPECIFIC
  PRESCRIPTION DRUGS OR COST SHARING [SPECIFIED BY DRUG FORMULARY]
         SECTION 2.  Subchapter B, Chapter 1369, Insurance Code, is
  amended by adding Section 1369.0542 to read as follows:
         Sec. 1369.0542.  EFFECT OF REDUCTIONS IN OUT-OF-POCKET
  EXPENSES ON COST SHARING. (a) This section applies only to a
  reduction in out-of-pocket expenses made by or on behalf of an
  enrollee for a prescription drug covered by the enrollee's health
  benefit plan for which:
               (1)  a generic equivalent does not exist;
               (2)  a generic equivalent does exist but the enrollee
  has obtained access to the prescription drug under the enrollee's
  health benefit plan using:
                     (A)  a prior authorization process;
                     (B)  a step therapy protocol; or
                     (C)  the health benefit plan issuer's exceptions
  and appeals process;
               (3)  an interchangeable biological product does not
  exist; or
               (4)  an interchangeable biological product does exist
  but the enrollee has obtained access to the prescription drug under
  the enrollee's health benefit plan using:
                     (A)  a prior authorization process;
                     (B)  a step therapy protocol; or
                     (C)  the health benefit plan issuer's exceptions
  and appeals process.
         (b)  An issuer of a health benefit plan that covers
  prescription drugs or a pharmacy benefit manager shall apply any
  third-party payment, financial assistance, discount, product
  voucher, or other reduction in out-of-pocket expenses made by or on
  behalf of an enrollee for a prescription drug to the enrollee's
  deductible, copayment, cost-sharing responsibility, or
  out-of-pocket maximum applicable to health benefits under the
  enrollee's plan.
         SECTION 3.  Section 1369.0542, Insurance Code, as added by
  this Act, applies only to a health benefit plan that is delivered,
  issued for delivery, or renewed on or after January 1, 2024. A
  health benefit plan delivered, issued for delivery, or renewed
  before January 1, 2024, 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, 2023.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 999 was passed by the House on April
  20, 2023, by the following vote:  Yeas 140, Nays 5, 1 present, not
  voting.
 
  ______________________________
  Chief Clerk of the House   
 
 
         I certify that H.B. No. 999 was passed by the Senate on May
  21, 2023, by the following vote:  Yeas 31, Nays 0.
 
  ______________________________
  Secretary of the Senate    
  APPROVED:  _____________________
                     Date          
   
            _____________________
                   Governor