Subscribe to receive our Floor Reports covering all the action on the Texas House and Senate floor!
Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans.
No significant fiscal implication to the State is anticipated.
HB 2099 would require the required notice provided by a health benefit plan issuer that modifies drug coverage under the plan to include a statement indicating that the issuer is modifying drug coverage, explaining the type of modification, and indicating that, on renewal of the plan, the issuer may not modify an enrollee's contracted benefit level for any prescription drug that was approved or covered under the previous plan year as provided by these bill provisions.
The bill would also include the increase of an out-of-pocket expense that an enrollee must pay for a drug and the reduction of the maximum drug coverage amount among the modifications that require such notice, and would remove the condition that the movement of a drug to a higher cost-sharing tier only requires notice if a general drug alternative is not available. Modifications favorable to enrollees would not require notice.
HB 2099 would also prohibit a health benefit plan issuer, on renewal of a plan, from modifying an enrollee's contracted benefit level for any prescription drug that was approved or covered under the plan in the immediately preceding plan year, and prescribed during that year for a medical condition or mental illness if: (1) the enrollee was covered by the plan on the date immediately preceding the renewal date; (2) a physician determines that the drug is the most appropriate course of treatment; and (3) a physician prescribes the drug the the medical condition or mental illness. Prohibited modifications would include removing a drug from a formulary, adding a prior authorization requirement, imposing a quantity limit for a drug, and moving a drug to a higher cost-sharing tier, among other things.
Texas Action recommends opposing this bill as a violation of limited our government principle. This bill would allow additional, undue governmental interference in the healthcare industry by prohibiting health benefit plan issuers from modifying contract terms related to certain prescription drugs upon policy renewal in order to reflect market changes. This effectively puts in place artificial price controls which prohibit insurers from adjusting prices based on market conditions.