Texas Statutes
Subchapter B. Coverage of Prescription Drugs Specified by Drug Formulary
Section 1369.054. Notice and Disclosure of Certain Information Required

Sec. 1369.054. NOTICE AND DISCLOSURE OF CERTAIN INFORMATION REQUIRED. An issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall:
(1) provide in plain language in the coverage documentation provided to each enrollee:
(A) notice that the plan uses one or more drug formularies;
(B) an explanation of what a drug formulary is;
(C) a statement regarding the method the issuer uses to determine the prescription drugs to be included in or excluded from a drug formulary;
(D) a statement of how often the issuer reviews the contents of each drug formulary; and
(E) notice that an enrollee may contact the issuer to determine whether a specific drug is included in a particular drug formulary;
(2) disclose to an individual on request, not later than the third business day after the date of the request, whether a specific drug is included in a particular drug formulary; and
(3) notify an enrollee and any other individual who requests information under this section that the inclusion of a drug in a drug formulary does not guarantee that an enrollee's health care provider will prescribe that drug for a particular medical condition or mental illness.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 501 (H.B. 1405), Sec. 4, eff. September 1, 2011.

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