Bill Text: TX HB82 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to pricing of and health benefit plan cost-sharing requirements for prescription insulin.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2021-02-25 - Referred to Insurance [HB82 Detail]
Download: Texas-2021-HB82-Introduced.html
| 87R1857 SMT-F | ||
| By: Lucio III | H.B. No. 82 | |
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| relating to pricing of and health benefit plan cost-sharing | ||
| requirements for prescription insulin. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1358, Insurance Code, is amended by | ||
| adding Subchapter C to read as follows: | ||
| SUBCHAPTER C. COST-SHARING LIMIT | ||
| Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including an individual, | ||
| group, blanket, or franchise insurance policy or insurance | ||
| agreement, a group hospital service contract, or a small or large | ||
| employer group contract or similar coverage document that is | ||
| offered by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (4) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (5) a reciprocal exchange operating under Chapter 942; | ||
| (6) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (7) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (8) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) This subchapter applies to group health coverage made | ||
| available by a school district in accordance with Section 22.004, | ||
| Education Code. | ||
| (c) Notwithstanding any provision in Chapter 1551, 1575, | ||
| 1579, or 1601 or any other law, this subchapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) basic coverage under Chapter 1601. | ||
| (d) Notwithstanding any other law, this subchapter applies | ||
| to coverage under: | ||
| (1) the child health plan program under Chapter 62, | ||
| Health and Safety Code, or the health benefits plan for children | ||
| under Chapter 63, Health and Safety Code; and | ||
| (2) the medical assistance program under Chapter 32, | ||
| Human Resources Code. | ||
| Sec. 1358.102. EXCEPTION. This subchapter does not apply | ||
| to: | ||
| (1) a health benefit plan that provides coverage: | ||
| (A) only for a specified disease or for another | ||
| single benefit; | ||
| (B) only for accidental death or dismemberment; | ||
| (C) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; | ||
| (D) as a supplement to a liability insurance | ||
| policy; | ||
| (E) for credit insurance; | ||
| (F) only for dental or vision care; | ||
| (G) only for hospital expenses; or | ||
| (H) only for indemnity for hospital confinement; | ||
| (2) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
| (3) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; | ||
| (4) a long-term care insurance policy, including a | ||
| nursing home fixed indemnity policy, unless the commissioner | ||
| determines that the policy provides benefit coverage so | ||
| comprehensive that the policy is a health benefit plan as described | ||
| by Section 1358.101; | ||
| (5) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code; or | ||
| (6) a workers' compensation insurance policy. | ||
| Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In | ||
| this section, "insulin" means a prescription drug that contains | ||
| insulin and is used to treat diabetes. The term does not include an | ||
| insulin drug that is administered to a patient intravenously. | ||
| (b) A health benefit plan may not impose a cost-sharing | ||
| provision for insulin if the total amount the enrollee is required | ||
| to pay exceeds $100 for a 30-day supply, regardless of the amount or | ||
| type of insulin needed to fill the enrollee's prescription. | ||
| SECTION 2. (a) In this section, "commission" means the | ||
| Health and Human Services Commission. | ||
| (b) The commission shall conduct a study evaluating pricing | ||
| of prescription insulin drugs to ensure adequate consumer | ||
| protections in pricing of prescription insulin drugs and consider | ||
| whether additional consumer protections are necessary. | ||
| (c) The commission shall request from health benefit plan | ||
| issuers and prescription drug manufacturers information concerning | ||
| the organization, business practices, pricing information, data, | ||
| reports, or other information the commission determines is | ||
| necessary to conduct the study. The commission shall also consider | ||
| any publicly available information related to prescription insulin | ||
| pricing. | ||
| (d) A health benefit plan issuer or prescription drug | ||
| manufacturer who receives a request from the commission under | ||
| Subsection (c) of this section shall furnish the commission with | ||
| the information as soon as practicable after the date the issuer or | ||
| manufacturer receives the request. | ||
| (e) The commission may not require a health benefit plan | ||
| issuer or prescription drug manufacturer to disclose trade secrets | ||
| in information provided to the commission under Subsection (d) of | ||
| this section. | ||
| (f) Not later than September 1, 2022, the commission shall | ||
| prepare and submit to the governor, the lieutenant governor, and | ||
| the speaker of the house of representatives a written report | ||
| containing the results of the study. The report must include: | ||
| (1) a summary of insulin pricing practices and | ||
| variables that contribute to pricing of health benefit plans; | ||
| (2) policy recommendations to control and prevent | ||
| overpricing of prescription insulin; and | ||
| (3) any other information the commission determines is | ||
| necessary. | ||
| (g) The commission shall publish the report described by | ||
| Subsection (f) of this section on its Internet website. | ||
| (h) This section expires September 1, 2023. | ||
| 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 January 1, 2022. A health benefit plan | ||
| 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 4. This Act takes effect September 1, 2021. | ||
