Bill Text: TX SB1148 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to health benefit plan coverage of prescription drugs for stage-four advanced, metastatic cancer.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-07 - Referred to Business & Commerce [SB1148 Detail]
Download: Texas-2019-SB1148-Introduced.html
86R11134 PMO-F | ||
By: Buckingham | S.B. No. 1148 |
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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. DEFINITION. In this subchapter, "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 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; 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. |