Texas Statutes
Subchapter E. Group Coverages
Section 1551.224. Mail Order Requirement for Prescription Drug Coverage Prohibited

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

Texas Statutes

Insurance Code

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

Subchapter E. Group Coverages

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 1551.205. Limitations

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 1551.2181. Exemption From Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services

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