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.
Spectrum: Partisan Bill (Democrat 1-0)
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. |