Bill Text: TX HB2180 | 2023-2024 | 88th Legislature | Comm Sub
Bill Title: Relating to the application of prescription drug price rebates to reduce health benefit plan enrollee cost sharing.
Spectrum: Moderate Partisan Bill (Republican 4-1)
Status: (Introduced - Dead) 2023-05-10 - Placed on General State Calendar [HB2180 Detail]
Download: Texas-2023-HB2180-Comm_Sub.html
| 88R4627 KBB-F | ||
| By: Harris of Anderson, Harless, Jetton, | H.B. No. 2180 | |
| et al. | ||
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| relating to the application of prescription drug price rebates to | ||
| reduce health benefit plan enrollee cost sharing. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter B-2 to read as follows: | ||
| SUBCHAPTER B-2. PRESCRIPTION DRUG PRICE REBATES | ||
| Sec. 1369.085. DEFINITIONS. In this subchapter: | ||
| (1) "Pharmacy benefit manager" and "prescription | ||
| drug" have the meanings assigned by Section 1369.501. | ||
| (2) "Price protection rebate" means a negotiated price | ||
| concession that accrues directly or indirectly to the health | ||
| benefit plan issuer or other party on behalf of the health benefit | ||
| plan issuer in the event of an increase in the wholesale acquisition | ||
| cost of a drug above a specified threshold. | ||
| (3) "Rebate" means: | ||
| (A) a negotiated price concession, including a | ||
| base price concession, without regard to whether the concession is | ||
| described as a rebate, and a reasonable estimate of any price | ||
| protection rebate or performance-based price concession that may | ||
| accrue directly or indirectly to the health benefit plan issuer | ||
| during the coverage year from a manufacturer, dispensing pharmacy, | ||
| or other party in connection with the dispensing or administration | ||
| of a prescription drug; and | ||
| (B) a reasonable estimate of each negotiated | ||
| price concession, fee, and other administrative cost that is passed | ||
| through, or is reasonably anticipated to be passed through, to the | ||
| health benefit plan issuer and reduces the health benefit plan | ||
| issuer's cost of covering a prescription drug. | ||
| Sec. 1369.086. 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) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (10) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (11) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (12) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| Sec. 1369.087. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER. | ||
| This subchapter does not apply to an issuer or provider of health | ||
| benefits under or a pharmacy benefit manager administering pharmacy | ||
| benefits under: | ||
| (1) the state Medicaid program, including the Medicaid | ||
| managed care program under Chapter 533, Government Code; | ||
| (2) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (3) the TRICARE military health system; or | ||
| (4) a workers' compensation insurance policy or other | ||
| form of providing medical benefits under Title 5, Labor Code. | ||
| Sec. 1369.088. APPLICATION OF PRESCRIPTION DRUG PRICE | ||
| REBATES TO COST SHARING. (a) An enrollee's cost sharing amount for | ||
| a prescription drug shall be calculated at the point of sale based | ||
| on a price that is reduced by an amount equal to or greater than all | ||
| rebates received or to be received by the enrollee's pharmacy | ||
| benefit manager or health benefit plan issuer in connection with | ||
| the dispensing or administration of the prescription drug to the | ||
| enrollee. | ||
| (b) This section may not be interpreted to prohibit a health | ||
| benefit plan issuer or pharmacy benefit manager from decreasing an | ||
| enrollee's cost sharing amount by an amount greater than the amount | ||
| required under this section. | ||
| (c) In complying with this section, a health benefit plan | ||
| issuer or pharmacy benefit manager may not publish or otherwise | ||
| reveal information regarding the actual amount of rebates the | ||
| health benefit plan issuer or pharmacy benefit manager receives on | ||
| a product-specific, product class-specific, | ||
| manufacturer-specific, or pharmacy-specific basis. The | ||
| information is a trade secret and is confidential and excepted from | ||
| disclosure under Chapter 552, Government Code. The health benefit | ||
| plan issuer or pharmacy benefit manager may not disclose the | ||
| information: | ||
| (1) directly or indirectly; | ||
| (2) in a manner that would allow for the | ||
| identification of an individual product, a class of products, the | ||
| manufacturer, or the pharmacy; or | ||
| (3) in a manner that would have the potential to | ||
| compromise the financial, competitive, or proprietary nature of the | ||
| information. | ||
| (d) A health benefit plan issuer or pharmacy benefit manager | ||
| shall ensure a third party or vendor who contracts with the health | ||
| benefit plan issuer or pharmacy benefit manager and may receive or | ||
| have access to rebate information complies with the confidentiality | ||
| required by this section. | ||
| SECTION 2. Subchapter B-2, Chapter 1369, Insurance Code, as | ||
| added by this Act, applies only to a health benefit plan delivered, | ||
| issued for delivery, or renewed on or after January 1, 2024. | ||
| SECTION 3. This Act takes effect September 1, 2023. | ||
