HBA-TYH H.B. 2495 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2495 By: Farabee Insurance 4/19/1999 Introduced BACKGROUND AND PURPOSE A formulary is a list of prescription drugs that a health plan will pay for. As managed care has grown, health plans have increasingly relied on formularies to control the rising cost of prescription medicines. Consumers with specific prescription drug needs often choose a health plan based on whether the prescription drug they require is part of the health plan's formulary. Currently, if a health plan changes the formulary in the middle of a contract period during which time a consumer is unable to change coverage, the consumer is left with a health plan that lacks the drug needed for the consumer's medical condition or mental illness. H.B. 2495 requires group health plans to continue covering a medication that used to be on its formulary for the remainder of the contract period. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Article 21.52J, Insurance Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.52J, as follows: Art. 21.52J. USE OF PRESCRIPTION DRUG FORMULARY BY GROUP HEALTH BENEFIT PLAN Sec. 1. DEFINITION. Defines "group health benefit plan." Sec. 2. SCOPE OF ARTICLE. Sets forth the scope of this article, specifying the plans that are applicable and the plans that are not applicable. Sec. 3. CHANGES TO PRESCRIPTION DRUG FORMULARY; CONTINUATION OF BENEFITS REQUIRED. Requires a group health benefit plan that covers prescription drugs, uses a formulary to specify which prescription drugs the plan will cover, and removes from its formulary a prescription drug that the plan had previously included in the formulary for a medical condition, to continue to provide benefits for the drug for an enrollee if the enrollee's prescribing health care provider prescribed the drug for the enrollee before the drug was removed from the formulary and continues to prescribe the drug for the same condition. Provides that a group health benefit plan must continue to cover the drug for the enrollee of this section until the enrollee's plan renewal date. Sec. 4. RULES. Authorizes the commissioner of insurance to adopt rules to implement this article. SECTION 2. Effective date: September 1, 1999. Makes application of this Act prospective. SECTION 3. Emergency clause.