Bill Text: TX SB270 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to health benefit plan coverage for abuse-deterrent opioid analgesic drugs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-01-30 - Referred to Business & Commerce [SB270 Detail]
Download: Texas-2017-SB270-Introduced.html
| 85R3192 MEW-D | ||
| By: Creighton | S.B. No. 270 | |
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| relating to health benefit plan coverage for abuse-deterrent opioid | ||
| analgesic drugs. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter J to read as follows: | ||
| SUBCHAPTER J. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS | ||
| Sec. 1369.451. DEFINITIONS. In this subchapter: | ||
| (1) "Abuse-deterrent opioid analgesic drug" means an | ||
| opioid analgesic drug that the United States Food and Drug | ||
| Administration has approved and for which the United States Food | ||
| and Drug Administration has approved abuse-deterrence labeling | ||
| that indicates the drug is expected to result in a meaningful | ||
| reduction in abuse. | ||
| (2) "Opioid analgesic drug" means a drug in the opioid | ||
| analgesic drug class that: | ||
| (A) is prescribed to treat moderate to severe | ||
| pain or other conditions; and | ||
| (B) may be: | ||
| (i) in an immediate-release or | ||
| extended-release form of the drug; | ||
| (ii) a single component drug; or | ||
| (iii) in combination with another drug. | ||
| Sec. 1369.452. 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 fraternal benefit society operating under | ||
| Chapter 885; | ||
| (4) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (5) a reciprocal exchange operating under Chapter 942; | ||
| (6) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (7) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (8) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) Notwithstanding Section 1501.251 or any other law, this | ||
| subchapter applies to a small employer health benefit plan subject | ||
| to Chapter 1501. | ||
| (c) Notwithstanding any other law, a standard health | ||
| benefit plan provided under Chapter 1507 must provide the coverage | ||
| required by this subchapter. | ||
| Sec. 1369.453. EXCEPTIONS. (a) This subchapter does not | ||
| apply to: | ||
| (1) a health benefit plan that provides coverage only: | ||
| (A) for a specified disease or for another | ||
| limited benefit other than for cancer; | ||
| (B) for accidental death or dismemberment; | ||
| (C) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; | ||
| (D) as a supplement to a liability insurance | ||
| policy; | ||
| (E) for credit insurance; | ||
| (F) for dental or vision care; or | ||
| (G) for indemnity for hospital confinement; | ||
| (2) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
| (3) a workers' compensation insurance policy; | ||
| (4) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; or | ||
| (5) a long-term care insurance policy, including a | ||
| nursing home fixed indemnity policy, unless the commissioner | ||
| determines that the policy provides benefit coverage so | ||
| comprehensive that the policy is a health benefit plan as described | ||
| by Section 1369.452. | ||
| (b) This subchapter does not apply to: | ||
| (1) the Medicaid managed care program operated under | ||
| Chapter 533, Government Code; | ||
| (2) the Medicaid program operated under Chapter 32, | ||
| Human Resources Code; or | ||
| (3) the child health plan program operated under | ||
| Chapter 62, Health and Safety Code. | ||
| Sec. 1369.454. REQUIRED COVERAGE FOR ABUSE-DETERRENT | ||
| OPIOID ANALGESIC DRUGS. (a) A health benefit plan must provide | ||
| coverage for abuse-deterrent opioid analgesic drugs. | ||
| (b) A health benefit plan issuer may not reduce or limit a | ||
| payment to a health care professional, or otherwise penalize the | ||
| professional, because the professional prescribes or dispenses an | ||
| abuse-deterrent opioid analgesic drug. | ||
| Sec. 1369.455. PRIOR AUTHORIZATION. (a) A health benefit | ||
| plan may require prior authorization for an abuse-deterrent opioid | ||
| analgesic drug in the same manner that the health benefit plan | ||
| requires prior authorization for an opioid analgesic drug that does | ||
| not have abuse-deterrent properties. | ||
| (b) A health benefit plan may not require an enrollee to use | ||
| an opioid analgesic drug that does not have abuse-deterrent | ||
| properties before prior authorization for an abuse-deterrent | ||
| opioid analgesic drug may be given. | ||
| SECTION 2. Subchapter J, 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, | ||
| 2018. A health benefit plan that is delivered, issued for delivery, | ||
| or renewed before January 1, 2018, is covered 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, 2017. | ||
