Texas 2017 - 85th Regular

Texas Senate Bill SB270 Compare Versions

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

Old	New	Differences
1	1	85R3192 MEW-D
2	2	By: Creighton S.B. No. 270
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for abuse-deterrent opioid
8	8	analgesic drugs.
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 J to read as follows:
12	12	SUBCHAPTER J. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS
13	13	Sec. 1369.451. DEFINITIONS. In this subchapter:
14	14	(1) "Abuse-deterrent opioid analgesic drug" means an
15	15	opioid analgesic drug that the United States Food and Drug
16	16	Administration has approved and for which the United States Food
17	17	and Drug Administration has approved abuse-deterrence labeling
18	18	that indicates the drug is expected to result in a meaningful
19	19	reduction in abuse.
20	20	(2) "Opioid analgesic drug" means a drug in the opioid
21	21	analgesic drug class that:
22	22	(A) is prescribed to treat moderate to severe
23	23	pain or other conditions; and
24	24	(B) may be:
25	25	(i) in an immediate-release or
26	26	extended-release form of the drug;
27	27	(ii) a single component drug; or
28	28	(iii) in combination with another drug.
29	29	Sec. 1369.452. APPLICABILITY OF SUBCHAPTER. (a) This
30	30	subchapter applies only to a health benefit plan that provides
31	31	benefits for medical or surgical expenses incurred as a result of a
32	32	health condition, accident, or sickness, including an individual,
33	33	group, blanket, or franchise insurance policy or insurance
34	34	agreement, a group hospital service contract, or an individual or
35	35	group evidence of coverage or similar coverage document that is
36	36	offered by:
37	37	(1) an insurance company;
38	38	(2) a group hospital service corporation operating
39	39	under Chapter 842;
40	40	(3) a fraternal benefit society operating under
41	41	Chapter 885;
42	42	(4) a stipulated premium company operating under
43	43	Chapter 884;
44	44	(5) a reciprocal exchange operating under Chapter 942;
45	45	(6) a health maintenance organization operating under
46	46	Chapter 843;
47	47	(7) a multiple employer welfare arrangement that holds
48	48	a certificate of authority under Chapter 846; or
49	49	(8) an approved nonprofit health corporation that
50	50	holds a certificate of authority under Chapter 844.
51	51	(b) Notwithstanding Section 1501.251 or any other law, this
52	52	subchapter applies to a small employer health benefit plan subject
53	53	to Chapter 1501.
54	54	(c) Notwithstanding any other law, a standard health
55	55	benefit plan provided under Chapter 1507 must provide the coverage
56	56	required by this subchapter.
57	57	Sec. 1369.453. EXCEPTIONS. (a) This subchapter does not
58	58	apply to:
59	59	(1) a health benefit plan that provides coverage only:
60	60	(A) for a specified disease or for another
61	61	limited benefit other than for cancer;
62	62	(B) for accidental death or dismemberment;
63	63	(C) for wages or payments in lieu of wages for a
64	64	period during which an employee is absent from work because of
65	65	sickness or injury;
66	66	(D) as a supplement to a liability insurance
67	67	policy;
68	68	(E) for credit insurance;
69	69	(F) for dental or vision care; or
70	70	(G) for indemnity for hospital confinement;
71	71	(2) a Medicare supplemental policy as defined by
72	72	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
73	73	(3) a workers' compensation insurance policy;
74	74	(4) medical payment insurance coverage provided under
75	75	a motor vehicle insurance policy; or
76	76	(5) a long-term care insurance policy, including a
77	77	nursing home fixed indemnity policy, unless the commissioner
78	78	determines that the policy provides benefit coverage so
79	79	comprehensive that the policy is a health benefit plan as described
80	80	by Section 1369.452.
81	81	(b) This subchapter does not apply to:
82	82	(1) the Medicaid managed care program operated under
83	83	Chapter 533, Government Code;
84	84	(2) the Medicaid program operated under Chapter 32,
85	85	Human Resources Code; or
86	86	(3) the child health plan program operated under
87	87	Chapter 62, Health and Safety Code.
88	88	Sec. 1369.454. REQUIRED COVERAGE FOR ABUSE-DETERRENT
89	89	OPIOID ANALGESIC DRUGS. (a) A health benefit plan must provide
90	90	coverage for abuse-deterrent opioid analgesic drugs.
91	91	(b) A health benefit plan issuer may not reduce or limit a
92	92	payment to a health care professional, or otherwise penalize the
93	93	professional, because the professional prescribes or dispenses an
94	94	abuse-deterrent opioid analgesic drug.
95	95	Sec. 1369.455. PRIOR AUTHORIZATION. (a) A health benefit
96	96	plan may require prior authorization for an abuse-deterrent opioid
97	97	analgesic drug in the same manner that the health benefit plan
98	98	requires prior authorization for an opioid analgesic drug that does
99	99	not have abuse-deterrent properties.
100	100	(b) A health benefit plan may not require an enrollee to use
101	101	an opioid analgesic drug that does not have abuse-deterrent
102	102	properties before prior authorization for an abuse-deterrent
103	103	opioid analgesic drug may be given.
104	104	SECTION 2. Subchapter J, Chapter 1369, Insurance Code, as
105	105	added by this Act, applies only to a health benefit plan that is
106	106	delivered, issued for delivery, or renewed on or after January 1,
107	107	2018. A health benefit plan that is delivered, issued for delivery,
108	108	or renewed before January 1, 2018, is covered by the law as it
109	109	existed immediately before the effective date of this Act, and that
110	110	law is continued in effect for that purpose.
111	111	SECTION 3. This Act takes effect September 1, 2017.