Texas 2017 - 85th Regular

Texas House Bill HB1539 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R7801 BEE-F
2	2	By: Thompson of Harris H.B. No. 1539
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of prescription drugs for
8	8	stage-four advanced, metastatic cancer.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1369, Insurance Code, is amended by
11	11	adding Subchapter E-1 to read as follows:
12	12	SUBCHAPTER E-1. COVERAGE OF PRESCRIPTION DRUGS FOR STAGE-FOUR
13	13	ADVANCED, METASTATIC CANCER
14	14	Sec. 1369.211. DEFINITION. In this subchapter, "stage-four
15	15	advanced, metastatic cancer" means cancer that has spread from the
16	16	primary or original site of the cancer to nearby tissues, lymph
17	17	nodes, or other areas or parts of the body.
18	18	Sec. 1369.212. APPLICABILITY OF SUBCHAPTER. (a) This
19	19	subchapter applies only to a health benefit plan that provides
20	20	benefits for medical or surgical expenses incurred as a result of a
21	21	health condition, accident, or sickness, including an individual,
22	22	group, blanket, or franchise insurance policy or insurance
23	23	agreement, a group hospital service contract, or an individual or
24	24	group evidence of coverage or similar coverage document that is
25	25	issued by:
26	26	(1) an insurance company;
27	27	(2) a group hospital service corporation operating
28	28	under Chapter 842;
29	29	(3) a health maintenance organization operating under
30	30	Chapter 843;
31	31	(4) an approved nonprofit health corporation that
32	32	holds a certificate of authority under Chapter 844;
33	33	(5) a multiple employer welfare arrangement that holds
34	34	a certificate of authority under Chapter 846;
35	35	(6) a stipulated premium company operating under
36	36	Chapter 884;
37	37	(7) a fraternal benefit society operating under
38	38	Chapter 885;
39	39	(8) a Lloyd's plan operating under Chapter 941; or
40	40	(9) an exchange operating under Chapter 942.
41	41	(b) Notwithstanding any other law, this subchapter applies
42	42	to:
43	43	(1) a small employer health benefit plan subject to
44	44	Chapter 1501, including coverage provided through a health group
45	45	cooperative under Subchapter B of that chapter;
46	46	(2) a standard health benefit plan issued under
47	47	Chapter 1507;
48	48	(3) a basic coverage plan under Chapter 1551;
49	49	(4) a basic plan under Chapter 1575;
50	50	(5) a primary care coverage plan under Chapter 1579;
51	51	(6) a plan providing basic coverage under Chapter
52	52	1601;
53	53	(7) health benefits provided by or through a church
54	54	benefits board under Subchapter I, Chapter 22, Business
55	55	Organizations Code;
56	56	(8) group health coverage made available by a school
57	57	district in accordance with Section 22.004, Education Code;
58	58	(9) the state Medicaid program, including the Medicaid
59	59	managed care program operated under Chapter 533, Government Code;
60	60	(10) the child health plan program under Chapter 62,
61	61	Health and Safety Code;
62	62	(11) a regional or local health care program operated
63	63	under Section 75.104, Health and Safety Code;
64	64	(12) a self-funded health benefit plan sponsored by a
65	65	professional employer organization under Chapter 91, Labor Code;
66	66	(13) county employee group health benefits provided
67	67	under Chapter 157, Local Government Code; and
68	68	(14) health and accident coverage provided by a risk
69	69	pool created under Chapter 172, Local Government Code.
70	70	(c) This subchapter applies to coverage under a group health
71	71	benefit plan provided to a resident of this state regardless of
72	72	whether the group policy, agreement, or contract is delivered,
73	73	issued for delivery, or renewed in this state.
74	74	Sec. 1369.213. PROHIBITED CONDUCT. (a) A health benefit
75	75	plan that provides coverage for stage-four advanced, metastatic
76	76	cancer may not require, before the health benefit plan provides
77	77	coverage of a prescription drug approved by the United States Food
78	78	and Drug Administration, that the enrollee:
79	79	(1) fail to successfully respond to a different drug;
80	80	or
81	81	(2) prove a history of failure of a different drug.
82	82	(b) This section applies only to a drug the use of which is:
83	83	(1) consistent with best practices for the treatment
84	84	of stage-four advanced, metastatic cancer; and
85	85	(2) supported by peer-reviewed medical literature.
86	86	SECTION 2. This Act applies only to a health benefit plan
87	87	delivered, issued for delivery, or renewed on or after January 1,
88	88	2018. A health benefit plan delivered, issued for delivery, or
89	89	renewed before January 1, 2018, is governed by the law as it existed
90	90	immediately before the effective date of this Act, and that law is
91	91	continued in effect for that purpose.
92	92	SECTION 3. This Act takes effect September 1, 2017.