Continuity of Prescription Drug Coverage
HB 1253 (Smithee) • HB 1405 (Smithee) • SB 547 (Deuell)
Update: May 2011
As of May 20th, HB 1405 had been passed unanimously by both the Texas House and Senate. It was delivered to the Governor's office and is awaiting his signature.
Earlier in the session, Rep. Smithee and Sen. Deuell substituted language into both HB 1253 and SB 547. The result is that HB 1405, HB 1253, and SB 547 are IDENTICAL bills. Therefore, we only need to pass one of the bills to achieve the protections we’re seeking for consumers—and HB 1405 is that bill.
Stay tuned for news!
To track the progress of this bill, please click here.
Many health care consumers—including those with comprehensive coverage—are subject to health insurance rules that allow for unfair and expected changes in their co-pays. Currently, small group and individual health care insurers can increase the price of a medication any time during the contract year, often by moving a drug to a higher cost-sharing tier.
These changes can lead to health problems and destroy a family’s finances. People living with multiple sclerosis and other chronic diseases rely on essential prescription medications to manage their disease and symptoms. For many, MS medications are their only hope for slowing the progression of the disease.
HB 1405 would require health plans to maintain prescription drug coverage for the life of the annual health insurance contract and HB 1253 (Smithee) would give enrollees notice of any changes to prescription drug coverage 60 days prior to contract renewal.
Tracy Brinton, like many Texans with MS, works very hard to stick to her family's budget in order to make her monthly health insurance premiums and prescription drug co-insurance:
"I have COBRA from my ex-husband's job for health insurance. It costs me $600 per month for the premium. My MS disease modifying drug costs $1,142 per month after insurance. Luckily, I qualified for a patient assistance program, and that dropped the cost of my prescription to $340 per month. I am grateful for that support, but it still means that I pay a minimum of $1,000 per month for health care, and that's before my living expenses and food. I should be able to count on the terms of my insurance policy not to change during the 12 months of my contract."
-Tracy Brinton, 10 years living with MS
Enrollees are surprised, confused, and often unprepared when their prescription drug co-payments increase during the contract year.
When insurers make these changes without warning, individuals often face painful choices between filling their prescriptions and paying for life’s necessities. People who cannot afford to pay for the increased prescription drug costs may cut back or go without essential medications, affecting their health.
Any individual who depends on prescription medications should be able to rely on their contract and the insurer’s drug formulary when selecting a health plan for a contract year. Providing this consistency is a safeguard that is essential to maintaining access to vital and often life-saving medicines.
In addition to disease-modifying medications for MS, prescription drugs used to treat other chronic diseases, such as rheumatoid arthritis, hepatitis C, cancer, and other, are often subject to a mid-year change.
HB 1405 is authored by Chairman John Smithee and joint-authored by Reps. Craig Eiland and Rick Hardcastle.
The National MS Society supports this legislation and believes it will provide an important safeguard for consumers, allowing them to budget for their health care costs and providing them with a continuity of coverage throughout their contract.