EFFECT OF REDUCTIONS IN OUT-OF-POCKET EXPENSES ON COST SHARING.
Tex. INS Code § 1369.0542.
in effect(a) This section applies only to a reduction in out-of-pocket expenses made by or on behalf of an enrollee for a prescription drug covered by the enrollee's health benefit plan for which:
(1) a generic equivalent does not exist;
(2) a generic equivalent does exist but the enrollee has obtained access to the prescription drug under the enrollee's health benefit plan using:
(A) a prior authorization process;
(B) a step therapy protocol; or
(C) the health benefit plan issuer's exceptions and appeals process;
(3) an interchangeable biological product does not exist; or
(4) an interchangeable biological product does exist but the enrollee has obtained access to the prescription drug under the enrollee's health benefit plan using:
(A) a prior authorization process;
(B) a step therapy protocol; or
(C) the health benefit plan issuer's exceptions and appeals process.
(b) An issuer of a health benefit plan that covers prescription drugs or a pharmacy benefit manager shall apply any third-party payment, financial assistance, discount, product voucher, or other reduction in out-of-pocket expenses made by or on behalf of an enrollee for a prescription drug to the enrollee's deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum applicable to health benefits under the enrollee's plan.
Added by Acts 2023, 88th Leg., R.S., Ch. 489 (H.B. 999 ), Sec. 2, eff. September 1, 2023.