Bill Text: TX SB166 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to a limit on cost-sharing requirements imposed by a health benefit plan for certain prescription insulin.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2021-03-03 - Referred to Business & Commerce [SB166 Detail]
Download: Texas-2021-SB166-Introduced.html
| 87R1900 SMT-F | ||
| By: Blanco | S.B. No. 166 | |
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| relating to a limit on cost-sharing requirements imposed by a | ||
| health benefit plan for certain 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. DEFINITIONS. In this subchapter: | ||
| (1) "Insulin" means a prescription drug that contains | ||
| insulin and is used to treat diabetes. | ||
| (2) "Pharmacy benefit manager" means a person, other | ||
| than a pharmacy or pharmacist, who acts as an administrator in | ||
| connection with pharmacy benefits. | ||
| Sec. 1358.102. 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 an individual or | ||
| group evidence of coverage or similar coverage document that is | ||
| issued by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this subchapter applies | ||
| to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507; | ||
| (3) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (9) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| (10) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (11) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; and | ||
| (12) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code. | ||
| (c) This subchapter applies to coverage under a group health | ||
| benefit plan provided to a resident of this state regardless of | ||
| whether the group policy, agreement, or contract is delivered, | ||
| issued for delivery, or renewed in this state. | ||
| Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. A | ||
| health benefit plan may not impose a cost-sharing provision for | ||
| insulin if the total amount the enrollee is required to pay exceeds | ||
| $25 for a 30-day supply. | ||
| Sec. 1358.104. LIMITATION ON PHARMACY CONTRACTS. A | ||
| contract between a health benefit plan issuer or pharmacy benefit | ||
| manager and a pharmacy may not contain a provision: | ||
| (1) authorizing the issuer's pharmacy benefit manager | ||
| or the pharmacy to charge an amount for insulin greater than the | ||
| amount described by Section 1358.103; | ||
| (2) requiring the pharmacy to collect an amount for | ||
| insulin greater than the amount described by Section 1358.103; or | ||
| (3) requiring an enrollee to make a cost-sharing | ||
| payment for covered insulin in an amount that exceeds the amount | ||
| described by Section 1358.103. | ||
| SECTION 2. (a) Section 1358.103, 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, | ||
| 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. | ||
| (b) Section 1358.104, Insurance Code, as added by this Act, | ||
| applies only to a contract entered into or renewed on or after the | ||
| effective date of this Act. | ||
| SECTION 3. This Act takes effect September 1, 2021. | ||
