H.B. No. 438

	AN ACT
	relating to health benefit plan coverage for orally administered
	anticancer medications.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1369, Insurance Code, is amended by
	adding Subchapter E to read as follows:
	SUBCHAPTER E. COVERAGE FOR ORALLY ADMINISTERED ANTICANCER
	MEDICATIONS
	Sec. 1369.201.  DEFINITIONS. In this subchapter:
	(1)  "Health benefit exchange" means an American Health
	Benefit Exchange administered by the federal government or created
	pursuant to Section 1311(b), Patient Protection and Affordable Care
	Act (42 U.S.C. Section 18031).
	(2)  "Qualified health plan" has the meaning assigned
	by Section 1301(a), Patient Protection and Affordable Care Act (42
	U.S.C. Section 18021).
	Sec. 1369.202.  APPLICABILITY OF SUBCHAPTER. This
	subchapter applies only to a health benefit plan, including a small
	employer health benefit plan written under Chapter 1501 or coverage
	provided by a health group cooperative under Subchapter B of that
	chapter, 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)  an exchange operating under Chapter 942;
	(6)  a Lloyd's plan operating under Chapter 941;
	(7)  a health maintenance organization operating under
	Chapter 843; or
	(8)  an approved nonprofit health corporation that
	holds a certificate of authority under Chapter 844.
	Sec. 1369.203.  EXCEPTION.  (a)  This subchapter does not
	apply to:
	(1)  a plan that provides coverage:
	(A)  only for fixed indemnity benefits for a
	specified disease or diseases;
	(B)  only 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)  only for dental or vision care; or
	(F)  only 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
	an automobile insurance policy;
	(5)  a credit insurance policy;
	(6)  a limited benefit policy that does not provide
	coverage for physical examinations or wellness exams;
	(7)  a multiple employer welfare arrangement that holds
	a certificate of authority under Chapter 846; or
	(8)  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 1369.201.
	(b)  This subchapter does not apply to a qualified health
	plan offered through a health benefit exchange.
	Sec. 1369.204.  REQUIRED COVERAGE FOR ORALLY ADMINISTERED
	ANTICANCER MEDICATIONS. (a)  A health benefit plan that provides
	coverage for cancer treatment must provide coverage for a
	prescribed, orally administered anticancer medication that is used
	to kill or slow the growth of cancerous cells on a basis no less
	favorable than intravenously administered or injected cancer
	medications that are covered as medical benefits by the plan.
	(b)  This section does not prohibit a health benefit plan
	from requiring prior authorization for an orally administered
	anticancer medication.  If an orally administered anticancer
	medication is authorized, the cost to the covered individual may
	not exceed the coinsurance or copayment that would be applied to a
	chemotherapy or other cancer treatment visit.
	(c)  A health benefit plan issuer may not reclassify
	anticancer medications or increase a coinsurance, copayment,
	deductible, or other out-of-pocket expense imposed on anticancer
	medications to achieve compliance with this section. Any plan
	change that otherwise increases an out-of-pocket expense applied to
	anticancer medications must also be applied to the majority of
	comparable medical or pharmaceutical benefits under the plan.
	(d)  This section does not prohibit a health benefit plan
	issuer from increasing cost-sharing for all benefits, including
	anticancer treatments.
	SECTION 2.  Subchapter E, 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,
	2012. A health benefit plan that is delivered, issued for delivery,
	or renewed before January 1, 2012, is covered by the law in effect
	at the time the plan was delivered, issued for delivery, or renewed,
	and that law is continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2011.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I certify that H.B. No. 438 was passed by the House on April
	21, 2011, by the following vote:  Yeas 147, Nays 1, 1 present, not
	voting.
	______________________________
	Chief Clerk of the House
	I certify that H.B. No. 438 was passed by the Senate on May
	10, 2011, by the following vote:  Yeas 31, Nays 0.
	______________________________
	Secretary of the Senate
	APPROVED:  _____________________
	Date
	_____________________
	Governor