Texas Insurance Code - INS § 1369.079. Formulary Disclosure Requirements

(1) included in a formulary and dispensed in a network pharmacy;  or

(2) covered under an individual health benefit plan and typically administered by a physician or health care provider.

(1) be electronically searchable by drug name;

(2) include for each drug the information required by Subsection (d) in the order listed in that subsection;  and

(3) indicate each formulary that applies to each individual health benefit plan issued by the issuer.

(1) the cost-sharing amount for each drug, including as applicable:

(2) a disclosure of prior authorization, step therapy, or other protocol requirements for each drug;

(3) if the individual health benefit plan uses a tier-based formulary, the specific tier for each drug listed in the formulary;

(4) a description of how prescription drugs will specifically be included in or excluded from the deductible, including a description of out-of-pocket costs for a prescription drug that may not apply to the deductible;

(5) identification of preferred formulary drugs;  and

(6) an explanation of coverage of each formulary drug.

(1) be publicly accessible to enrollees, prospective enrollees, and others without necessity of providing a password, a user name, or personally identifiable information;

(2) allow consumers to electronically search formulary information by the name under which the individual health benefit plan is marketed;  and

(3) be accessible through a direct link that is displayed on each page of the formulary disclosure that lists each drug as required under Subsection (c).