Source: Texas Department of Insurance | April 1, 2020
The Texas Department of Insurance (TDI) announced on April 1, 2020, an emergency rule to make it easier for Texans with TDI-regulated health insurance to get early refills and to get prescriptions at more locations, including by home delivery.
“It’s critical that patients have uninterrupted access to the prescriptions they need,” said Insurance Commissioner Kent Sullivan. “We also want to reduce the need for patients to leave their homes for prescriptions and risk exposure to infection. These temporary changes will help achieve that.”
The temporary emergency rule requires health plans regulated by TDI to:
- Pay for a 90-day refill of covered medications regardless of when the prescription was last refilled, unless specifically prohibited by law as in the case of controlled substances.
- Allow prescriptions to be filled at out-of-network pharmacies at no additional cost to the consumer if the drug isn’t available quickly through mail order or at an in-network pharmacy within 30 miles.
- Allow for substitutions if the plan’s preferred drug isn’t available due to shortages or distribution issues.
- Waive any requirement for a consumer’s signature unless specifically required by law.
TDI-regulated plans cover about 15% of the Texas market, including plans purchased through Healthcare.gov. The insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them.
The emergency rule doesn’t apply to self-insured employer plans, Medicare, workers’ compensation, or the state’s employee or teacher retirement plans.