Bill Text: TX HB999 | 2023-2024 | 88th Legislature | Enrolled
Bill Title: 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.
Spectrum: Bipartisan Bill
Status: (Passed) 2023-06-10 - Effective on 9/1/23 [HB999 Detail]
Download: Texas-2023-HB999-Enrolled.html
| H.B. No. 999 | ||
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| 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 [ |
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| 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 | ||
