HBA-ATS H.B. 3663 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 3663
By: Wise
Insurance
4/19/1999
Introduced



BACKGROUND AND PURPOSE 

H.B. 3663 guarantees people in small towns access to pharmaceutical
services and prescription drugs.  This bill requires an issuer of a plan
that provides pharmacy or prescription drug benefits and requires or
encourages enrollees in the plan to use a network pharmacy to obtain
pharmaceutical services or prescription drugs for which benefits are
provided under the plan to maintain at least two network pharmacies in each
municipality in which an enrollee in the plan resides.  If there are fewer
than two pharmacies in the municipality, the insurer must comply with rules
adopted by the commissioner of insurance  to ensure adequate access to
benefits for pharmaceutical services and prescription drugs.  Compliance
with these mandates does not affect the duty of an insurer to provide
benefits for pharmaceutical services or prescription drugs through an
adequate number of pharmacies. 

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 21.52K, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.52K, as follows: 

ARTICLE 21.52K.  MINIMUM NUMBER OF NETWORK PHARMACIES

Sec. 1.  DEFINITIONS.  Defines "health benefit plan," "network pharmacy,"
and "pharmacy." 

Sec. 2.  SCOPE OF ARTICLE.  (a) Specifies that Article 21.52K applies only
to a health benefit  plan (plan) that provides benefits for medical or
surgical expenses incurred because of a health condition, accident, or
sickness.  These types of plans include an individual, group, blanket, or
franchise insurance policy or insurance agreement, a group hospital service
contract, and individual or group coverage.  Specifies that these plans are
offered by an insurance company; a group hospital service corporation; a
fraternal benefit society; a stipulated premium insurance company; a
reciprocal exchange; a health maintenance organization; a multiple employer
welfare arrangement; and an approved nonprofit health corporation. 

(b) Provides that Article 21.52K does not apply to a plan that provides
coverage only for a specific disease or other limited benefit; only for
accidental death or dismemberment; for wages or payments for a period
during which an employee is absent from work because of sickness or injury;
as a supplement to liability insurance; for credit insurance; only for
dental or vision care; only for hospital expenses; or only for indemnity
for hospital confinement.  Also excluded is a small employer health benefit
plan; a Medicare supplemental policy; workers' compensation insurance
coverage; medical payment insurance coverage issued as part of a motor
vehicle insurance policy; or a long-term care policy. 

 Sec. 3.  MINIMUM NUMBER OF PHARMACIES REQUIRED IN NETWORK.  Provides that
this section applies only to a plan that provides pharmacy or prescription
drug benefits and requires or encourages enrollees in the plan to use a
network pharmacy to obtain pharmaceutical services or prescription drugs
for which benefits are provided under the plan. Requires the insurer to
maintain at least two network pharmacies in each municipality in the state
in which an enrollee in the plan resides.  Requires the insurer, if there
are fewer than two pharmacies in the municipality, to comply with rules
adopted by the commissioner of insurance (commissioner) under this article
to ensure adequate access to benefits for pharmaceutical services and
prescription drugs.  Sets forth that compliance with this article does not
affect the duty of an insurer to provide benefits for pharmaceutical
services or prescription drugs through an adequate number of pharmacies.  

Sec. 4.  RULES.  Requires the commissioner to adopt rules to implement this
article. 

SECTION 2.Effective date: September 1, 1999.
Makes application of this Act prospective for a health benefit plan
delivered, issued for delivery, or renewed on or after January 1, 2000. 

SECTION 3.Emergency clause.