BLUE VISION^SM

Dec. 8, 2023

Texas House Bill 999: Applying Third-Party Payments to Member Cost Sharing

• Individual/Family plans, including grandfathered and transitional
• Student health plans
• Fully insured group plans, including small, mid-market and large, PPO, HMO, EPO and POS and Grandfathered/Transitional
• Blue Balance Funded^SM plans
• Does not apply to ERS/TRS

What you need to know:
Texas House Bill 999 requires insurers and pharmacy benefit managers to credit third-party payments, financial assistance, discounts or vouchers for covered prescription drugs toward a member’s deductible/out-of-pocket maximum.

What’s the impact to plans?
Impacted members using coupons, copay cards, etc. will see those amounts applied to their plan deductibles/out-of-pocket maximums.

• Members of high-deductible health plans will get the cost reduction from the coupon at the point of sale, but they must meet their deductible first before the coupon applies to their deductible/out-of-pocket maximum.
• Groups with a pharmacy benefit manager other than Prime Therapeutics^® should check with their pharmacy benefit manager to confirm coverage.

This change will be reflected in benefit booklet materials.

When does this go into effect?
Sept. 1, 2023, for plans delivered, issued for delivery or renewed on or after Jan. 1, 2024.

Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com  is an online resource offered by Prime Therapeutics.