Texas 2017 - 85th Regular

Texas House Bill HB3864 Compare Versions

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

Old	New	Differences
1	1	By: Rodriguez of Travis H.B. No. 3864
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to health benefit plan coverage for abuse-deterrent opioid
7	7	analgesic drugs.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Chapter 1369, Insurance Code, is amended by
10	10	adding Subchapter J to read as follows:
11	11	SUBCHAPTER J. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS
12	12	Sec. 1369.451. DEFINITIONS. In this subchapter:
13	13	(1) "Abuse-deterrent opioid analgesic drug" means an
14	14	opioid analgesic drug that the United States Food and Drug
15	15	Administration has approved and for which the United States Food
16	16	and Drug Administration has approved abuse-deterrence labeling
17	17	that indicates the drug is expected to result in a meaningful
18	18	reduction in abuse.
19	19	(2) "Opioid analgesic drug" means a drug in the opioid
20	20	analgesic drug class that:
21	21	(A) is prescribed to treat moderate to severe
22	22	pain or other conditions; and
23	23	(B) may be:
24	24	(i) in an immediate-release or
25	25	extended-release form of the drug;
26	26	(ii) a single component drug; or
27	27	(iii) in combination with another drug.
28	28	Sec. 1369.452. APPLICABILITY OF SUBCHAPTER. (a) This
29	29	subchapter applies only to a health benefit plan that provides
30	30	benefits for medical or surgical expenses incurred as a result of a
31	31	health condition, accident, or sickness, including an individual,
32	32	group, blanket, or franchise insurance policy or insurance
33	33	agreement, a group hospital service contract, or an individual or
34	34	group evidence of coverage or similar coverage document that is
35	35	offered by:
36	36	(1) an insurance company;
37	37	(2) a group hospital service corporation operating
38	38	under Chapter 842;
39	39	(3) a fraternal benefit society operating under
40	40	Chapter 885;
41	41	(4) a stipulated premium company operating under
42	42	Chapter 884;
43	43	(5) a reciprocal exchange operating under Chapter 942;
44	44	(6) a health maintenance organization operating under
45	45	Chapter 843;
46	46	(7) a multiple employer welfare arrangement that holds
47	47	a certificate of authority under Chapter 846; or
48	48	(8) an approved nonprofit health corporation that
49	49	holds a certificate of authority under Chapter 844.
50	50	(b) Notwithstanding Section 1501.251 or any other law, this
51	51	subchapter applies to a small employer health benefit plan subject
52	52	to Chapter 1501.
53	53	(c) Notwithstanding any other law, a standard health
54	54	benefit plan provided under Chapter 1507 must provide the coverage
55	55	required by this subchapter.
56	56	Sec. 1369.453. EXCEPTIONS. (a) This subchapter does not
57	57	apply to:
58	58	(1) a health benefit plan that provides coverage only:
59	59	(A) for a specified disease or for another
60	60	limited benefit other than for cancer;
61	61	(B) for accidental death or dismemberment;
62	62	(C) for wages or payments in lieu of wages for a
63	63	period during which an employee is absent from work because of
64	64	sickness or injury;
65	65	(D) as a supplement to a liability insurance
66	66	policy;
67	67	(E) for credit insurance;
68	68	(F) for dental or vision care; or
69	69	(G) for indemnity for hospital confinement;
70	70	(2) a Medicare supplemental policy as defined by
71	71	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
72	72	(3) a workers' compensation insurance policy;
73	73	(4) medical payment insurance coverage provided under
74	74	a motor vehicle insurance policy; or
75	75	(5) a long-term care insurance policy, including a
76	76	nursing home fixed indemnity policy, unless the commissioner
77	77	determines that the policy provides benefit coverage so
78	78	comprehensive that the policy is a health benefit plan as described
79	79	by Section 1369.452.
80	80	(b) This subchapter does not apply to:
81	81	(1) the Medicaid managed care program operated under
82	82	Chapter 533, Government Code;
83	83	(2) the Medicaid program operated under Chapter 32,
84	84	Human Resources Code; or
85	85	(3) the child health plan program operated under
86	86	Chapter 62, Health and Safety Code.
87	87	Sec. 1369.454. REQUIRED COVERAGE FOR ABUSE-DETERRENT
88	88	OPIOID ANALGESIC DRUGS. (a) A health benefit plan must provide
89	89	coverage for abuse-deterrent opioid analgesic drugs.
90	90	(b) A health benefit plan issuer may not reduce or limit a
91	91	payment to a health care professional, or otherwise penalize the
92	92	professional, because the professional prescribes or dispenses an
93	93	abuse-deterrent opioid analgesic drug.
94	94	Sec. 1369.455. PRIOR AUTHORIZATION. (a) A health benefit
95	95	plan may require prior authorization for an abuse-deterrent opioid
96	96	analgesic drug in the same manner that the health benefit plan
97	97	requires prior authorization for an opioid analgesic drug that does
98	98	not have abuse-deterrent properties.
99	99	(b) A health benefit plan may not require an enrollee to use
100	100	an opioid analgesic drug that does not have abuse-deterrent
101	101	properties before prior authorization for an abuse-deterrent
102	102	opioid analgesic drug may be given.
103	103	SECTION 2. Subchapter J, Chapter 1369, Insurance Code, as
104	104	added by this Act, applies only to a health benefit plan that is
105	105	delivered, issued for delivery, or renewed on or after January 1,
106	106	2018. A health benefit plan that is delivered, issued for delivery,
107	107	or renewed before January 1, 2018, is covered by the law as it
108	108	existed immediately before the effective date of this Act, and that
109	109	law is continued in effect for that purpose.
110	110	SECTION 3. This Act takes effect September 1, 2017.