Bill Text: TX SB2051 | 2021-2022 | 87th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to step therapy protocols required by health benefit plans for coverage of prescription drugs for serious mental illnesses.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-05-25 - Placed on General State Calendar [SB2051 Detail]
Download: Texas-2021-SB2051-Introduced.html
Bill Title: Relating to step therapy protocols required by health benefit plans for coverage of prescription drugs for serious mental illnesses.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-05-25 - Placed on General State Calendar [SB2051 Detail]
Download: Texas-2021-SB2051-Introduced.html
| 87R1885 SMT-F | ||
| By: Menéndez | S.B. No. 2051 | |
|
|
||
|
|
||
| relating to health benefit plan coverage of prescription drugs for | ||
| serious mental illnesses. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter E-2 to read as follows: | ||
| SUBCHAPTER E-2. PRESCRIPTION DRUG COVERAGE FOR SERIOUS MENTAL | ||
| ILLNESSES | ||
| Sec. 1369.221. DEFINITION. In this subchapter, "serious | ||
| mental illness" has the meaning assigned by Section 1355.001. | ||
| Sec. 1369.222. 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 contract 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) a reciprocal 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) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; and | ||
| (10) 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. 1369.223. PROHIBITED CONDUCT. (a) A health benefit | ||
| plan that provides coverage for a serious mental illness 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) prescribed by a physician or other health care | ||
| provider for the serious mental illness; | ||
| (2) determined by the prescribing physician or health | ||
| care provider in consultation with the enrollee as the most | ||
| appropriate course of treatment for the serious mental illness; and | ||
| (3) approved by the United States Food and Drug | ||
| Administration. | ||
| (c) This section applies only to a drug prescribed to an | ||
| enrollee who is 18 years of age or older. | ||
| (d) This section does not affect a pharmacist's authority to | ||
| substitute a generic equivalent or one or more interchangeable | ||
| biological products under Section 562.008, Occupations Code, for a | ||
| prescription drug prescribed for a serious mental illness. | ||
| SECTION 2. This Act applies only to a health benefit plan | ||
| delivered, issued for delivery, or renewed on or after January 1, | ||
| 2022. A health benefit plan delivered, issued for delivery, or | ||
| renewed before January 1, 2022, 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, 2021. | ||
