Texas 2019 - 86th Regular

Texas House Bill HB1584 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 1584
	1	+	By: Thompson of Harris, et al. H.B. No. 1584
	2	+	(Senate Sponsor - Buckingham)
	3	+	(In the Senate - Received from the House May 7, 2019;
	4	+	May 10, 2019, read first time and referred to Committee on Business &
	5	+	Commerce; May 20, 2019, reported favorably by the following vote:
	6	+	Yeas 8, Nays 0; May 20, 2019, sent to printer.)
	7	+	Click here to see the committee vote
2	8
3	9
	10	+	A BILL TO BE ENTITLED
4	11		AN ACT
5	12		relating to health benefit plan coverage of prescription drugs for
6	13		stage-four advanced, metastatic cancer.
7	14		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	15		SECTION 1. Chapter 1369, Insurance Code, is amended by
9	16		adding Subchapter E-1 to read as follows:
10	17		SUBCHAPTER E-1. COVERAGE OF PRESCRIPTION DRUGS FOR STAGE-FOUR
11	18		ADVANCED, METASTATIC CANCER
12	19		Sec. 1369.211. DEFINITIONS. In this subchapter:
13	20		(1) "Associated conditions" means the symptoms or side
14	21		effects associated with stage-four advanced, metastatic cancer or
15	22		its treatment and which, in the judgment of the health care
16	23		practitioner, further jeopardize the health of a patient if left
17	24		untreated.
18	25		(2) "Stage-four advanced, metastatic cancer" means
19	26		cancer that has spread from the primary or original site of the
20	27		cancer to nearby tissues, lymph nodes, or other areas or parts of
21	28		the body.
22	29		Sec. 1369.212. APPLICABILITY OF SUBCHAPTER. (a) This
23	30		subchapter applies only to a health benefit plan that provides
24	31		benefits for medical or surgical expenses or pharmacy benefits
25	32		incurred as a result of a health condition, accident, or sickness,
26	33		including an individual, group, blanket, or franchise insurance
27	34		policy or insurance agreement, a group hospital service contract,
28	35		or an individual or group evidence of coverage or similar coverage
29	36		document that is issued by:
30	37		(1) an insurance company;
31	38		(2) a group hospital service corporation operating
32	39		under Chapter 842;
33	40		(3) a health maintenance organization operating under
34	41		Chapter 843;
35	42		(4) an approved nonprofit health corporation that
36	43		holds a certificate of authority under Chapter 844;
37	44		(5) a multiple employer welfare arrangement that holds
38	45		a certificate of authority under Chapter 846;
39	46		(6) a stipulated premium company operating under
40	47		Chapter 884;
41	48		(7) a fraternal benefit society operating under
42	49		Chapter 885;
43	50		(8) a Lloyd's plan operating under Chapter 941; or
44	51		(9) an exchange operating under Chapter 942.
45	52		(b) Notwithstanding any other law, this subchapter applies
46	53		to:
47	54		(1) a small employer health benefit plan subject to
48	55		Chapter 1501, including coverage provided through a health group
49	56		cooperative under Subchapter B of that chapter;
50	57		(2) a standard health benefit plan issued under
51	58		Chapter 1507;
52	59		(3) a basic coverage plan under Chapter 1551;
53	60		(4) a basic plan under Chapter 1575;
54	61		(5) a primary care coverage plan under Chapter 1579;
55	62		(6) a plan providing basic coverage under Chapter
56	63		1601;
57	64		(7) health benefits provided by or through a church
58	65		benefits board under Subchapter I, Chapter 22, Business
59	66		Organizations Code;
60	67		(8) group health coverage made available by a school
61	68		district in accordance with Section 22.004, Education Code;
62	69		(9) the state Medicaid program, including the Medicaid
63	70		managed care program operated under Chapter 533, Government Code;
64	71		(10) the child health plan program under Chapter 62,
65	72		Health and Safety Code;
66	73		(11) a regional or local health care program operated
67	74		under Section 75.104, Health and Safety Code; and
68	75		(12) a self-funded health benefit plan sponsored by a
69	76		professional employer organization under Chapter 91, Labor Code.
70	77		(c) This subchapter applies to coverage under a group health
71	78		benefit plan provided to a resident of this state regardless of
72	79		whether the group policy, agreement, or contract is delivered,
73	80		issued for delivery, or renewed in this state.
74	81		Sec. 1369.213. PROHIBITED CONDUCT. (a) A health benefit
75	82		plan that provides coverage for stage-four advanced, metastatic
76	83		cancer and associated conditions may not require, before the health
77	84		benefit plan provides coverage of a prescription drug approved by
78	85		the United States Food and Drug Administration, that the enrollee:
79	86		(1) fail to successfully respond to a different drug;
80	87		or
81	88		(2) prove a history of failure of a different drug.
82	89		(b) This section applies only to a drug the use of which is:
83	90		(1) consistent with best practices for the treatment
84	91		of stage-four advanced, metastatic cancer or an associated
85		-	condition;
86		-	(2) supported by peer-reviewed, evidence-based
87		-	literature; and
88		-	(3) approved by the United States Food and Drug
89		-	Administration.
	92	+	condition; and
	93	+	(2) supported by peer-reviewed medical literature.
90	94		SECTION 2. This Act applies only to a health benefit plan
91	95		delivered, issued for delivery, or renewed on or after January 1,
92	96		2020. A health benefit plan delivered, issued for delivery, or
93	97		renewed before January 1, 2020, is governed by the law as it existed
94	98		immediately before the effective date of this Act, and that law is
95	99		continued in effect for that purpose.
96	100		SECTION 3. This Act takes effect September 1, 2019.
97		-	______________________________ ______________________________
98		-	President of the Senate Speaker of the House
99		-	I certify that H.B. No. 1584 was passed by the House on May 7,
100		-	2019, by the following vote: Yeas 126, Nays 19, 1 present, not
101		-	voting; and that the House concurred in Senate amendments to H.B.
102		-	No. 1584 on May 24, 2019, by the following vote: Yeas 115, Nays 24,
103		-	2 present, not voting.
104		-	______________________________
105		-	Chief Clerk of the House
106		-	I certify that H.B. No. 1584 was passed by the Senate, with
107		-	amendments, on May 22, 2019, by the following vote: Yeas 30, Nays
108		-	1.
109		-	______________________________
110		-	Secretary of the Senate
111		-	APPROVED: __________________
112		-	Date
113		-	__________________
114		-	Governor
	101	+	* * * * *