Bill Text: TX SB827 | 2021-2022 | 87th Legislature | Enrolled
Bill Title: Relating to health benefit plan cost-sharing requirements for prescription insulin.
Spectrum: Bipartisan Bill
Status: (Passed) 2021-06-14 - Effective on 9/1/21 [SB827 Detail]
Download: Texas-2021-SB827-Enrolled.html
| S.B. No. 827 | ||
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| relating to health benefit plan cost-sharing requirements for | ||
| 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. 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 a small or large | ||
| employer group contract or similar coverage document that is | ||
| offered by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (4) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (5) a reciprocal exchange operating under Chapter 942; | ||
| (6) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (7) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (8) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) This subchapter applies to group health coverage made | ||
| available by a school district in accordance with Section 22.004, | ||
| Education Code. | ||
| (c) Notwithstanding any provision in Chapter 1551, 1575, | ||
| 1579, or 1601 or any other law, this subchapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) basic coverage under Chapter 1601. | ||
| (d) Notwithstanding any other law, this subchapter applies | ||
| to coverage under: | ||
| (1) the child health plan program under Chapter 62, | ||
| Health and Safety Code, or the health benefits plan for children | ||
| under Chapter 63, Health and Safety Code; and | ||
| (2) the medical assistance program under Chapter 32, | ||
| Human Resources Code. | ||
| Sec. 1358.102. EXCEPTION. This subchapter does not apply | ||
| to: | ||
| (1) a health benefit plan that provides coverage: | ||
| (A) only for a specified disease or for another | ||
| single benefit; | ||
| (B) only for accidental death or dismemberment; | ||
| (C) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; | ||
| (D) as a supplement to a liability insurance | ||
| policy; | ||
| (E) for credit insurance; | ||
| (F) only for dental or vision care; | ||
| (G) only for hospital expenses; or | ||
| (H) only for indemnity for hospital confinement; | ||
| (2) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
| (3) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; | ||
| (4) a long-term care insurance policy, including a | ||
| nursing home fixed indemnity policy, unless the commissioner | ||
| determines that the policy provides benefit coverage so | ||
| comprehensive that the policy is a health benefit plan as described | ||
| by Section 1358.101; | ||
| (5) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code; or | ||
| (6) a workers' compensation insurance policy. | ||
| Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In | ||
| this section, "insulin" means a prescription drug that contains | ||
| insulin and is used to treat diabetes. The term does not include an | ||
| insulin drug that is administered to a patient intravenously. | ||
| (b) A health benefit plan may not impose a cost-sharing | ||
| provision for insulin that is included in the health benefit plan's | ||
| formulary if the total amount the enrollee is required to pay | ||
| exceeds $25 per prescription for a 30-day supply, regardless of the | ||
| amount or type of insulin needed to fill the enrollee's | ||
| prescription. | ||
| Sec. 1358.104. FORMULARY REQUIREMENT. A health benefit | ||
| plan must include at least one insulin from each therapeutic class | ||
| in the plan's formulary. | ||
| SECTION 2. The changes in law made by this Act apply 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. | ||
| SECTION 3. This Act takes effect September 1, 2021. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I hereby certify that S.B. No. 827 passed the Senate on | ||
| March 25, 2021, by the following vote: Yeas 27, Nays 3; and that | ||
| the Senate concurred in House amendment on May 27, 2021, by the | ||
| following vote: Yeas 28, Nays 3. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| I hereby certify that S.B. No. 827 passed the House, with | ||
| amendment, on May 24, 2021, by the following vote: Yeas 140, | ||
| Nays 5, one present not voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| Approved: | ||
| ______________________________ | ||
| Date | ||
| ______________________________ | ||
| Governor | ||
