Bill Text: TX HB1586 | 2021-2022 | 87th Legislature | Engrossed
Bill Title: Relating to health benefit plan coverage of clinician-administered drugs.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Engrossed - Dead) 2021-05-17 - Referred to Business & Commerce [HB1586 Detail]
Download: Texas-2021-HB1586-Engrossed.html
| By: Lucio III, Oliverson, Metcalf | H.B. No. 1586 | |
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| relating to health benefit plan coverage of clinician-administered | ||
| drugs. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter L to read as follows: | ||
| SUBCHAPTER L. CLINICIAN-ADMINISTERED DRUGS | ||
| Sec. 1369.551. DEFINITIONS. In this subchapter: | ||
| (1) "Administer" means to directly apply a drug to the | ||
| body of a patient by injection, inhalation, ingestion, or any other | ||
| means. | ||
| (2) "Clinician-administered drug" means an outpatient | ||
| prescription drug other than a vaccine that: | ||
| (A) cannot reasonably be: | ||
| (i) self-administered by the patient to | ||
| whom the drug is prescribed; or | ||
| (ii) administered by an individual | ||
| assisting the patient with the self-administration; and | ||
| (B) is typically administered: | ||
| (i) by a physician or other health care | ||
| provider authorized under the laws of this state to administer the | ||
| drug, including when acting under a physician's delegation and | ||
| supervision; and | ||
| (ii) in a physician's office, hospital | ||
| outpatient infusion center, or other clinical setting. | ||
| (3) "Health care provider" means an individual who is | ||
| licensed, certified, or otherwise authorized to provide health care | ||
| services in this state. | ||
| (4) "Physician" means an individual licensed to | ||
| practice medicine in this state. | ||
| Sec. 1369.552. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses 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 | ||
| offered 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) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (4) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (5) a regional or local health care program operating | ||
| under Section 75.104, Health and Safety Code; and | ||
| (6) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code. | ||
| (c) This subchapter does not apply to an issuer or provider | ||
| of health benefits under or a pharmacy benefit manager | ||
| administering pharmacy benefits under a workers' compensation | ||
| insurance policy or other form of providing medical benefits under | ||
| Title 5, Labor Code. | ||
| Sec. 1369.553. CERTAIN LIMITATIONS ON COVERAGE OF | ||
| CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit plan | ||
| issuer may not, for a patient with a cancer or cancer-related | ||
| diagnosis: | ||
| (1) require a clinician-administered drug to be | ||
| dispensed by a pharmacy selected by the health benefit plan issuer; | ||
| (2) require that a clinician-administered drug or the | ||
| administration of a clinician-administered drug be covered as a | ||
| pharmacy benefit rather than a medical benefit; | ||
| (3) if a clinician-administered drug is otherwise | ||
| covered, limit or exclude coverage for the clinician-administered | ||
| drug when not dispensed by a pharmacy selected by the health benefit | ||
| plan issuer; or | ||
| (4) prohibit a physician or health care provider from | ||
| obtaining or administering a clinician-administered drug that the | ||
| physician or provider is otherwise permitted to obtain or | ||
| administer by law. | ||
| (b) Nothing in this section may be construed to: | ||
| (1) authorize a person to administer a drug when | ||
| otherwise prohibited under the laws of this state or federal law; or | ||
| (2) modify drug administration requirements under the | ||
| laws of this state, including any requirements related to | ||
| delegation and supervision of drug administration. | ||
| SECTION 2. Subchapter L, Chapter 1369, Insurance Code, as | ||
| added by this Act, applies only to a health benefit plan that is | ||
| delivered, issued for delivery, or renewed on or after January 1, | ||
| 2022. | ||
| SECTION 3. This Act takes effect September 1, 2021. | ||
