Bill Text: TX HB1227 | 2017-2018 | 85th Legislature | Enrolled
Bill Title: Relating to the transparency of certain information related to prescription drug coverage provided by certain health benefit plans.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2017-05-26 - Effective on 9/1/17 [HB1227 Detail]
Download: Texas-2017-HB1227-Enrolled.html
H.B. No. 1227 |
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relating to the transparency of certain information related to | ||
prescription drug coverage provided by certain health benefit | ||
plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
adding Subchapter B-1 to read as follows: | ||
SUBCHAPTER B-1. TRANSPARENCY REQUIREMENTS FOR CERTAIN INDIVIDUAL | ||
HEALTH BENEFIT PLANS | ||
Sec. 1369.076. DEFINITIONS. In this subchapter, terms | ||
defined by Subchapter B have the meanings assigned by that | ||
subchapter. | ||
Sec. 1369.077. APPLICABILITY OF SUBCHAPTER. This | ||
subchapter applies only to an individual health benefit plan to | ||
which Subchapter B applies. | ||
SECTION 2. Sections 1369.0542 through 1369.0544, Insurance | ||
Code, are transferred to Subchapter B-1, Chapter 1369, Insurance | ||
Code, as added by this Act, redesignated as Sections 1369.078 | ||
through 1369.080, Insurance Code, and amended to read as follows: | ||
Sec. 1369.078 [ |
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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 [ |
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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 [ |
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plan and typically administered by a physician or health care | ||
provider. | ||
(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 | ||
follows: | ||
(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 | ||
formulary; | ||
(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 [ |
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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 [ |
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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. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I certify that H.B. No. 1227 was passed by the House on April | ||
6, 2017, by the following vote: Yeas 144, Nays 0, 1 present, not | ||
voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
I certify that H.B. No. 1227 was passed by the Senate on May | ||
12, 2017, by the following vote: Yeas 31, Nays 0. | ||
______________________________ | ||
Secretary of the Senate | ||
APPROVED: _____________________ | ||
Date | ||
_____________________ | ||
Governor |