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.