The House of Medicine continued its recent roll in the Texas House of Representatives on Wednesday afternoon when the House passed a bill that would ban health plans from switching or otherwise monkeying around with a patient’s effective, appropriate medication regimen.
By a 101-45 vote, the lower chamber OK’d House Bill 1646 by Rep. Stan Lambert (R-Abilene). HB 1646 would prevent insurers, when renewing a patient’s plan, from modifying the patient’s “contracted benefit level for any prescription drug” the insurer approved or covered the previous plan year, if the patient’s physician determines the drug “is the most appropriate course of treatment.”
Modifications insurers couldn’t make, under HB 1646, include:
- Adding a prior authorization requirement for the drug;
- Imposing a step therapy restriction, in which insurers require patients to “fail first” on a cheaper drug before allowing coverage for the more expensive one;
- Imposing or altering a quantity limit;
- Moving the drug to a higher cost-sharing tier; and
- Increasing a patient’s out-of-pocket expense for the drug.
The bill is now ready for Senate consideration.
Also Wednesday, the House postponed consideration of TMA-supported House Bill 4272 by Rep. Stephanie Klick (R-Fort Worth) to modernize the state’s immunization registry and maintain disaster immunization records for at least seven years. It moved to Thursday’s postponed business calendar.
Pharmacist immunization bill clears House
Despite dogged TMA advocacy to stop it, a bill authorizing pharmacists to immunize children as young as 3 passed the House early Thursday afternoon.
The troubling scope-of-practice measure, House Bill 678 by Philip Cortez (D-San Antonio), would give pharmacists immunization authority well beyond their current scope of practice, which allows them to give flu shots to children aged 7 and older. The Texas Pediatric Society has joined with TMA to lead opposition to HB 678. Pediatricians have concerns the bill could cause a decrease in well-child visits, as immunizations often give physician-led care teams the opportunity to provide comprehensive care.
Prior auth bills reaching the House floor
Two of medicine’s most impactful measures to curb the relentless impediments of prior authorization earned spots on the House calendar in the latter half of this week – one Thursday, one today.
Scheduled for consideration on the floor Thursday was House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood), which contains not one, but two major defenses against preauthorization and its related burdens: It would allow physicians who achieve a certain percentage of prior authorization approvals for a service to be “gold-carded” out of preapprovals for that service the following year. The year after that gold-card year, doctors would once again be evaluated on their preauthorizations for the potential of earning another gold card for the year that follows.
HB 3459 also would require utilization reviews to be conducted by physicians of the same or a similar specialty as the doctor who requested approval for the treatment.
Representative Bonnen is also the author of House Bill 4012, which requires insurers to provide price disclosures on certain services that require preauthorization. That measure was on the House schedule for today.