Texas 2023 - 88th Regular

Texas House Bill HB1647 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 1647
2	2
3	3
4	4	AN ACT
5	5	relating to health benefit plan coverage of clinician-administered
6	6	drugs.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Chapter 1369, Insurance Code, is amended by
9	9	adding Subchapter Q to read as follows:
10	10	SUBCHAPTER Q. CLINICIAN-ADMINISTERED DRUGS
11	11	Sec. 1369.761. DEFINITIONS. In this subchapter:
12	12	(1) "Administer" means to directly apply a drug to the
13	13	body of a patient by injection, inhalation, ingestion, or any other
14	14	means.
15	15	(2) "Clinician-administered drug" means an outpatient
16	16	prescription drug other than a vaccine that:
17	17	(A) cannot reasonably be:
18	18	(i) self-administered by the patient to
19	19	whom the drug is prescribed; or
20	20	(ii) administered by an individual
21	21	assisting the patient with the self-administration; and
22	22	(B) is typically administered:
23	23	(i) by a physician or other health care
24	24	provider authorized under the laws of this state to administer the
25	25	drug, including when acting under a physician's delegation and
26	26	supervision; and
27	27	(ii) in a physician's office.
28	28	(3) "Health care provider" means an individual who is
29	29	licensed, certified, or otherwise authorized to provide health care
30	30	services in this state.
31	31	(4) "Physician" means an individual licensed to
32	32	practice medicine in this state.
33	33	Sec. 1369.762. APPLICABILITY OF SUBCHAPTER. (a) This
34	34	subchapter applies only to a health benefit plan that provides
35	35	benefits for medical or surgical expenses incurred as a result of a
36	36	health condition, accident, or sickness, including an individual,
37	37	group, blanket, or franchise insurance policy or insurance
38	38	agreement, a group hospital service contract, or an individual or
39	39	group evidence of coverage or similar coverage document that is
40	40	offered by:
41	41	(1) an insurance company;
42	42	(2) a group hospital service corporation operating
43	43	under Chapter 842;
44	44	(3) a health maintenance organization operating under
45	45	Chapter 843;
46	46	(4) an approved nonprofit health corporation that
47	47	holds a certificate of authority under Chapter 844;
48	48	(5) a multiple employer welfare arrangement that holds
49	49	a certificate of authority under Chapter 846;
50	50	(6) a stipulated premium company operating under
51	51	Chapter 884;
52	52	(7) a fraternal benefit society operating under
53	53	Chapter 885;
54	54	(8) a Lloyd's plan operating under Chapter 941; or
55	55	(9) an exchange operating under Chapter 942.
56	56	(b) Notwithstanding any other law, this subchapter applies
57	57	to:
58	58	(1) a small employer health benefit plan subject to
59	59	Chapter 1501, including coverage provided through a health group
60	60	cooperative under Subchapter B of that chapter;
61	61	(2) a standard health benefit plan issued under
62	62	Chapter 1507;
63	63	(3) group health coverage made available by a school
64	64	district in accordance with Section 22.004, Education Code;
65	65	(4) a regional or local health care program operating
66	66	under Section 75.104, Health and Safety Code; and
67	67	(5) a self-funded health benefit plan sponsored by a
68	68	professional employer organization under Chapter 91, Labor Code.
69	69	Sec. 1369.763. EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.
70	70	(a) This subchapter does not apply to an issuer or provider of
71	71	health benefits under or a pharmacy benefit manager administering
72	72	pharmacy benefits under:
73	73	(1) the state Medicaid program, including the Medicaid
74	74	managed care program under Chapter 533, Government Code;
75	75	(2) the child health plan program under Chapter 62,
76	76	Health and Safety Code;
77	77	(3) the TRICARE military health system; or
78	78	(4) a workers' compensation insurance policy or other
79	79	form of providing medical benefits under Title 5, Labor Code.
80	80	(b) This subchapter does not apply to a prescription drug
81	81	administered in a hospital, hospital facility-based practice
82	82	setting, or hospital outpatient infusion center.
83	83	Sec. 1369.764. CERTAIN LIMITATIONS ON COVERAGE OF
84	84	CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) Subject to
85	85	Subsection (b), a health benefit plan issuer may not, for an
86	86	enrollee with a chronic, complex, rare, or life-threatening medical
87	87	condition:
88	88	(1) require clinician-administered drugs to be
89	89	dispensed only by certain pharmacies or only by pharmacies
90	90	participating in the health benefit plan issuer's network;
91	91	(2) if a clinician-administered drug is otherwise
92	92	covered, limit or exclude coverage for such drugs based on the
93	93	enrollee's choice of pharmacy or because the drug was not dispensed
94	94	by a pharmacy that participates in the health benefit plan issuer's
95	95	network;
96	96	(3) require a physician or health care provider
97	97	participating in the health benefit plan issuer's network to bill
98	98	for or be reimbursed for the delivery and administration of
99	99	clinician-administered drugs under the pharmacy benefit instead of
100	100	the medical benefit without:
101	101	(A) informed written consent of the patient; and
102	102	(B) a written attestation by the patient's
103	103	physician or health care provider that a delay in the drug's
104	104	administration will not place the patient at an increased health
105	105	risk; or
106	106	(4) require that an enrollee pay an additional fee,
107	107	higher copay, higher coinsurance, second copay, second
108	108	coinsurance, or any other price increase for
109	109	clinician-administered drugs based on the enrollee's choice of
110	110	pharmacy or because the drug was not dispensed by a pharmacy that
111	111	participates in the health benefit plan issuer's network.
112	112	(b) Subsection (a) applies only if the patient's physician
113	113	or health care provider determines that:
114	114	(1) a delay of care would make disease progression
115	115	probable; or
116	116	(2) the use of a pharmacy within the health benefit
117	117	plan issuer's network would:
118	118	(A) make death or patient harm probable;
119	119	(B) potentially cause a barrier to the patient's
120	120	adherence to or compliance with the patient's plan of care; or
121	121	(C) because of the timeliness of the delivery or
122	122	dosage requirements, necessitate delivery by a different pharmacy.
123	123	(c) Nothing in this section may be construed to:
124	124	(1) authorize a person to administer a drug when
125	125	otherwise prohibited under the laws of this state or federal law; or
126	126	(2) modify drug administration requirements under the
127	127	laws of this state, including any requirements related to
128	128	delegation and supervision of drug administration.
129	129	SECTION 2. Subchapter Q, Chapter 1369, Insurance Code, as
130	130	added by this Act, applies only to a health benefit plan that is
131	131	delivered, issued for delivery, or renewed on or after January 1,
132	132	2024.
133	133	SECTION 3. This Act takes effect September 1, 2023.
134	134	______________________________ ______________________________
135	135	President of the Senate Speaker of the House
136	136	I certify that H.B. No. 1647 was passed by the House on April
137	137	21, 2023, by the following vote: Yeas 139, Nays 1, 1 present, not
138	138	voting.
139	139	______________________________
140	140	Chief Clerk of the House
141	141	I certify that H.B. No. 1647 was passed by the Senate on May
142	142	19, 2023, by the following vote: Yeas 31, Nays 0.
143	143	______________________________
144	144	Secretary of the Senate
145	145	APPROVED: _____________________
146	146	Date
147	147	_____________________
148	148	Governor