Bill Text: TX HB698 | 2019-2020 | 86th Legislature | Comm Sub
Bill Title: Relating to certain protected practices of pharmacists and pharmacies regarding amounts charged for prescription drugs.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2019-04-29 - Committee report sent to Calendars [HB698 Detail]
Download: Texas-2019-HB698-Comm_Sub.html
| 86R26825 PMO-F | |||
| By: Blanco, Oliverson, Sheffield | H.B. No. 698 | ||
| Substitute the following for H.B. No. 698: | |||
| By: Lucio III | C.S.H.B. No. 698 | ||
|
|
||
|
|
||
| relating to certain protected practices of pharmacists and | ||
| pharmacies regarding amounts charged for prescription drugs. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter K to read as follows: | ||
| SUBCHAPTER K. PROTECTED PRACTICES REGARDING PRESCRIPTION DRUG | ||
| CHARGES | ||
| Sec. 1369.501. DEFINITIONS. In this subchapter: | ||
| (1) "Enrollee" means an individual who is covered | ||
| under a health benefit plan, including a covered dependent. | ||
| (2) "Prescription drug" has the meaning assigned by | ||
| Section 551.003, Occupations Code. | ||
| Sec. 1369.502. 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. 1369.503. PROTECTED PRACTICES BY PHARMACISTS AND | ||
| PHARMACIES. An issuer of a health benefit plan that covers | ||
| prescription drugs or a pharmacy benefit manager as defined by | ||
| Section 4151.151 may not, as a condition of a contract with a | ||
| pharmacist or pharmacy providing a prescription drug or in any | ||
| other manner, prohibit or otherwise restrict a pharmacist or | ||
| pharmacy from or penalize a pharmacist or pharmacy for: | ||
| (1) informing an enrollee that the amount the | ||
| pharmacist or pharmacy charges for a prescription drug is less than | ||
| the enrollee's copayment, deductible, or coinsurance for the drug | ||
| under the plan or otherwise providing information to the enrollee | ||
| regarding the cost of the drug; or | ||
| (2) selling a prescription drug covered by the plan | ||
| for an amount that is less than the enrollee's copayment, | ||
| deductible, or coinsurance for the drug under the plan. | ||
| SECTION 2. Subchapter K, Chapter 1369, 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, | ||
| 2020. A plan delivered, issued for delivery, or renewed before | ||
| January 1, 2020, 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 3. If before implementing any provision of this Act | ||
| a state agency determines that a waiver or authorization from a | ||
| federal agency is necessary for implementation of that provision, | ||
| the agency affected by the provision shall request the waiver or | ||
| authorization and may delay implementing that provision until the | ||
| waiver or authorization is granted. | ||
| SECTION 4. This Act takes effect September 1, 2019. | ||
