| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to amounts charged to an enrollee in a health benefit plan |
|
|
for prescription drugs covered by the plan. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1369.001, Insurance Code, is amended by |
|
|
adding Subdivision (2-a) to read as follows: |
|
|
(2-a) "Enrollee" means an individual who is covered |
|
|
under a health benefit plan, including a covered dependent. |
|
|
SECTION 2. Subchapter A, Chapter 1369, Insurance Code, is |
|
|
amended by adding Section 1369.0041 to read as follows: |
|
|
Sec. 1369.0041. LIMIT ON PAYMENT REQUIRED UNDER PLAN. A |
|
|
health benefit plan issuer that covers prescription drugs may not |
|
|
require an enrollee to make a payment for a prescription drug at the |
|
|
point of sale in an amount greater than the lesser of: |
|
|
(1) the applicable copayment; |
|
|
(2) the allowable claim amount for the prescription |
|
|
drug; or |
|
|
(3) the amount an individual would pay for the drug if |
|
|
the individual purchased the drug without using a health benefit |
|
|
plan or any other source of drug benefits or discounts. |
|
|
SECTION 3. Section 1369.0041, 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, 2018. A plan |
|
|
delivered, issued for delivery, or renewed before January 1, 2018, |
|
|
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, 2017. |