Sec. 1551.224. MAIL ORDER REQUIREMENT FOR PRESCRIPTION DRUG COVERAGE PROHIBITED. (a) The board of trustees or a health benefit plan under this chapter that provides benefits for prescription drugs may not require a participant in the group benefits program to purchase a prescription drug through a mail order program.
(b) Except as provided by Subsection (c), the board of trustees or a health benefit plan shall require that a participant who chooses to obtain a prescription drug through a retail pharmacy or other method other than by mail order pay a deductible, copayment, coinsurance, or other cost-sharing obligation to cover the additional cost of obtaining a prescription drug through that method rather than by mail order.
(c) The board of trustees or a health benefit plan may not require a participant who obtains a multiple-month supply of a prescription drug from a retail pharmacy under Section 1560.003 to pay a deductible, copayment, coinsurance, or other cost-sharing obligation that differs from the amount the participant pays for a multiple-month supply of that drug through a mail order program.
Added by Acts 2003, 78th Leg., ch. 213, Sec. 2, eff. Sept. 1, 2003.
Renumbered from Insurance Code, Section 1551.219 by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 17.001(52), eff. September 1, 2007.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1207 (S.B. 704), Sec. 4, eff. September 1, 2009.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle H - Health Benefits and Other Coverages for Governmental Employees
Chapter 1551 - Texas Employees Group Benefits Act
Section 1551.201. Establishment
Section 1551.2011. Employee Awareness and Education
Section 1551.202. Authority to Define Basic Coverages
Section 1551.203. Authority to Define Optional Coverages
Section 1551.204. Authority to Define Voluntary Coverages
Section 1551.206. Cafeteria Plan
Section 1551.207. Premium Conversion Benefit Portion of Cafeteria Plan
Section 1551.208. Determination to Self-Fund
Section 1551.209. Coverage Exempt From Insurance Law
Section 1551.210. Actuarial Advice for Self-Funded Coverage
Section 1551.211. Contingency Reserve Fund for Self-Funded Coverage
Section 1551.212. Firms to Administer Self-Funded Coverage
Section 1551.213. Bids for Purchased Coverage
Section 1551.214. Selection of Bids for Purchased Coverage
Section 1551.215. Accounting by Carrier Providing Purchased Coverage
Section 1551.216. Special Contingency Reserve
Section 1551.217. Use of Employee's Salary in Computation of Premium or Coverage
Section 1551.218. Prior Authorization for Certain Drugs
Section 1551.219. Disease Management Services
Section 1551.220. Beneficiary Causing Death of Participant or Beneficiary of Participant
Section 1551.222. Incentive Payments
Section 1551.224. Mail Order Requirement for Prescription Drug Coverage Prohibited
Section 1551.225. Bariatric Surgery Coverage
Section 1551.226. Tobacco Cessation Coverage
Section 1551.227. Tricare Military Health System Supplemental Plan
Section 1551.228. Emergency Care Payments
Section 1551.229. Out-of-Network Facility-Based Provider Payments
Section 1551.230. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider Payments