Bill Text: TX HB1584 | 2019-2020 | 86th Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to health benefit plan coverage of prescription drugs for stage-four advanced, metastatic cancer.
Spectrum: Slight Partisan Bill (Republican 8-5)
Status: (Passed) 2019-06-15 - Effective on 9/1/19 [HB1584 Detail]
Download: Texas-2019-HB1584-Comm_Sub.html
Bill Title: Relating to health benefit plan coverage of prescription drugs for stage-four advanced, metastatic cancer.
Spectrum: Slight Partisan Bill (Republican 8-5)
Status: (Passed) 2019-06-15 - Effective on 9/1/19 [HB1584 Detail]
Download: Texas-2019-HB1584-Comm_Sub.html
By: Thompson of Harris, et al. | H.B. No. 1584 | |
(Senate Sponsor - Buckingham) | ||
(In the Senate - Received from the House May 7, 2019; | ||
May 10, 2019, read first time and referred to Committee on Business & | ||
Commerce; May 20, 2019, reported favorably by the following vote: | ||
Yeas 8, Nays 0; May 20, 2019, sent to printer.) | ||
|
||
|
||
relating to health benefit plan coverage of prescription drugs for | ||
stage-four advanced, metastatic cancer. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
adding Subchapter E-1 to read as follows: | ||
SUBCHAPTER E-1. COVERAGE OF PRESCRIPTION DRUGS FOR STAGE-FOUR | ||
ADVANCED, METASTATIC CANCER | ||
Sec. 1369.211. DEFINITIONS. In this subchapter: | ||
(1) "Associated conditions" means the symptoms or side | ||
effects associated with stage-four advanced, metastatic cancer or | ||
its treatment and which, in the judgment of the health care | ||
practitioner, further jeopardize the health of a patient if left | ||
untreated. | ||
(2) "Stage-four advanced, metastatic cancer" means | ||
cancer that has spread from the primary or original site of the | ||
cancer to nearby tissues, lymph nodes, or other areas or parts of | ||
the body. | ||
Sec. 1369.212. APPLICABILITY OF SUBCHAPTER. (a) This | ||
subchapter applies only to a health benefit plan that provides | ||
benefits for medical or surgical expenses or pharmacy benefits | ||
incurred as a result of a health condition, accident, or sickness, | ||
including an individual, group, blanket, or franchise insurance | ||
policy or insurance agreement, a group hospital service contract, | ||
or an individual or group evidence of coverage or similar coverage | ||
document that is issued by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a health maintenance organization operating under | ||
Chapter 843; | ||
(4) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844; | ||
(5) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; | ||
(6) a stipulated premium company operating under | ||
Chapter 884; | ||
(7) a fraternal benefit society operating under | ||
Chapter 885; | ||
(8) a Lloyd's plan operating under Chapter 941; or | ||
(9) an exchange operating under Chapter 942. | ||
(b) Notwithstanding any other law, this subchapter applies | ||
to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507; | ||
(3) a basic coverage plan under Chapter 1551; | ||
(4) a basic plan under Chapter 1575; | ||
(5) a primary care coverage plan under Chapter 1579; | ||
(6) a plan providing basic coverage under Chapter | ||
1601; | ||
(7) health benefits provided by or through a church | ||
benefits board under Subchapter I, Chapter 22, Business | ||
Organizations Code; | ||
(8) group health coverage made available by a school | ||
district in accordance with Section 22.004, Education Code; | ||
(9) the state Medicaid program, including the Medicaid | ||
managed care program operated under Chapter 533, Government Code; | ||
(10) the child health plan program under Chapter 62, | ||
Health and Safety Code; | ||
(11) a regional or local health care program operated | ||
under Section 75.104, Health and Safety Code; and | ||
(12) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code. | ||
(c) This subchapter applies to coverage under a group health | ||
benefit plan provided to a resident of this state regardless of | ||
whether the group policy, agreement, or contract is delivered, | ||
issued for delivery, or renewed in this state. | ||
Sec. 1369.213. PROHIBITED CONDUCT. (a) A health benefit | ||
plan that provides coverage for stage-four advanced, metastatic | ||
cancer and associated conditions may not require, before the health | ||
benefit plan provides coverage of a prescription drug approved by | ||
the United States Food and Drug Administration, that the enrollee: | ||
(1) fail to successfully respond to a different drug; | ||
or | ||
(2) prove a history of failure of a different drug. | ||
(b) This section applies only to a drug the use of which is: | ||
(1) consistent with best practices for the treatment | ||
of stage-four advanced, metastatic cancer or an associated | ||
condition; and | ||
(2) supported by peer-reviewed medical literature. | ||
SECTION 2. This Act applies only to a health benefit plan | ||
delivered, issued for delivery, or renewed on or after January 1, | ||
2020. A health benefit plan delivered, issued for delivery, or | ||
renewed before January 1, 2020, is governed by the law as it existed | ||
immediately before the effective date of this Act, and that law is | ||
continued in effect for that purpose. | ||
SECTION 3. This Act takes effect September 1, 2019. | ||
* * * * * |