Bill Text: TX HB1584 | 2019-2020 | 86th Legislature | Enrolled

Texas House Bill 1584 (Prior Session Legislation)

Bill Title: Relating to health benefit plan coverage of prescription drugs for stage-four advanced, metastatic cancer.

Sponsorship: Slight Partisan Bill (Republican 8-5)

Status: (Passed) 2019-06-15 - Effective on 9/1/19 [HB1584 Detail]

Download: Texas-2019-HB1584-Enrolled.html



	H.B. No. 1584




	AN ACT
	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;
	(2) supported by peer-reviewed, evidence-based
	literature; and
	(3) approved by the United States Food and Drug
	Administration.

	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.


	______________________________	______________________________
	President of the Senate	Speaker of the House


	I certify that H.B. No. 1584 was passed by the House on May 7,
	2019, by the following vote: Yeas 126, Nays 19, 1 present, not
	voting; and that the House concurred in Senate amendments to H.B.
	No. 1584 on May 24, 2019, by the following vote: Yeas 115, Nays 24,
	2 present, not voting.

	______________________________
	Chief Clerk of the House

	I certify that H.B. No. 1584 was passed by the Senate, with
	amendments, on May 22, 2019, by the following vote: Yeas 30, Nays
	1.

	______________________________
	Secretary of the Senate
	APPROVED: __________________
	Date

	__________________
	Governor