bill to let employers and insurers pool drug buying

The text as introduced · 637 words

90R1394 MPF-D

By: Blanco
S.B. No. 271

A BILL TO BE ENTITLED

AN ACT

relating to a prescription drug purchasing pool for certain health

benefit plan issuers and employers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle A, Title 6, Health and Safety Code, is

amended by adding Chapter 447 to read as follows:

CHAPTER 447. PRESCRIPTION DRUG PURCHASING POOL

Sec. 447.001. DEFINITIONS. In this chapter:

(1) "Commission" means the Health and Human Services

Commission.

(2) "Health benefit plan issuer" means an insurer,

health maintenance organization, or other entity authorized to

provide health benefits coverage under the laws of this state.

(3) "Participant" means a health benefit plan issuer,

qualified public employer, or qualified private employer enrolled

in the prescription drug purchasing pool established under Section

447.002.

(4) "Qualified private employer" means a self-insured

private employer conducting business in this state.

(5) "Qualified public employer" means:

(A) a political subdivision of this state,

including a county, municipality, or public school district;

(B) a university system or an institution of

higher education, as those terms are defined by Section 61.003,

Education Code; or

(C) a quasi-public agency.

Sec. 447.002. PRESCRIPTION DRUG PURCHASING POOL. (a) The

commission shall establish a prescription drug purchasing pool

through which a participating health benefit plan issuer, qualified

public employer, or qualified private employer may purchase

prescription drugs for their employees, employees' dependents, and

retirees from vendors at a discounted rate or under terms the

commission negotiates.

(b) The prescription drug purchasing pool does not

constitute a risk pool, and each health benefit plan issuer,

qualified public employer, and qualified private employer

participating in the pool is responsible for paying the cost of a

claim or prescription drug in accordance with any applicable health

benefit coverage agreement with their employees, employees'

dependents, and retirees.

Sec. 447.003. ADMINISTRATION OF PRESCRIPTION DRUG

PURCHASING POOL. The executive commissioner by rule shall

establish procedures for administering the prescription drug

purchasing pool, including procedures establishing:

(1) the eligibility criteria for a health benefit plan

issuer, qualified public employer, or qualified private employer to

participate in the pool;

(2) the manner by which a health benefit plan issuer,

qualified public employer, or qualified private employer may enroll

in the pool;

(3) the duration of eligibility for a health benefit

plan issuer, qualified public employer, or qualified private

employer to participate in the pool;

(4) the method by which a participant contributes

money to the pool; and

(5) the method for disenrolling a participant from the

pool or terminating a participant's eligibility to participate in

the pool.

Sec. 447.004. OPTIONAL STOP LOSS COVERAGE. The commission

shall provide a participant the option to purchase stop loss

coverage from an insurer at a rate the commission negotiates.

Sec. 447.005. MULTIPLE EMPLOYER PRESCRIPTION DRUG

PURCHASING AGREEMENTS. (a) Two or more participants may jointly

purchase through the prescription drug purchasing pool

prescription drugs for their employees, employees' dependents, and

retirees.

(b) An arrangement to jointly purchase prescription drugs

under this section does not constitute a multiple employer welfare

arrangement, as defined by Section 846.001, Insurance Code.

Sec. 447.006. RULES. The executive commissioner shall

adopt rules as necessary to implement this chapter.

SECTION 2. As soon as practicable after the effective date

of this Act, the Health and Human Services Commission shall

establish the prescription drug purchasing pool as required by

Chapter 447, Health and Safety Code, as added by this Act.

SECTION 3. The Health and Human Services Commission is

required to implement a provision of this Act only if the

legislature appropriates money specifically for that purpose. If

the legislature does not appropriate money specifically for that

purpose, the commission may, but is not required to, implement a

provision of this Act using other money available for that purpose.

SECTION 4. This Act takes effect September 1, 2027.