HBA-MSH H.B. 1982 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1982
By: Farabee
Insurance
4/1/2001
Introduced



BACKGROUND AND PURPOSE 

Current law requires a group health benefit plan that offers prescription
drug benefits to make a prescription drug that was approved or covered for
a medical condition or mental illness available to each enrollee at the
contracted benefit level until the enrollee's plan renewal date, regardless
of whether the prescribed drug has been removed from the health benefit
plan's drug formulary.  This  requirement has necessitated the development
of multiple formularies by the health plans and has created administrative
problems.  House Bill 1982 requires a health plan to make available a
prescription drug that was prescribed for an enrollee during the plan year
and sets forth certain exceptions. 

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. 

ANALYSIS

House Bill 1982 amends the Insurance Code to require a group health benefit
plan that offers prescription drug benefits to make a prescription drug
that was prescribed for an enrollee during the plan year available to the
enrollee at the contracted benefit level until the enrollee's plan renewal
date, regardless of whether the prescribed drug has been removed from the
health benefit plan's drug formulary. The bill provides that this does not
require a group health benefit plan to continue to provide prescription
drug benefits for a prescription drug if the United States Food and Drug
Administration (FDA) prohibits the sale or use of the drug or the use of
the drug as prescribed to an enrollee, or the FDA or the drug's
manufacturer identifies a side effect, adverse reaction, or other health
risk associated with the drug that was unknown at the time the drug was
prescribed to the enrollee or is substantially more severe as determined
under rules adopted by the commissioner of insurance than was believed at
the time the drug was prescribed to the enrollee.  

EFFECTIVE DATE

September 1, 2001.  The Act applies only to a group health benefit plan
that is delivered, issued for delivery, or renewed on or after January 1,
2002.