Bill Text: TX HB907 | 2021-2022 | 87th Legislature | Comm Sub


Bill Title: Relating to prior authorization for prescription drug benefits related to the treatment of autoimmune diseases.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2021-04-19 - Placed on General State Calendar [HB907 Detail]

Download: Texas-2021-HB907-Comm_Sub.html
  87R16610 JES-D
 
  By: Johnson of Dallas H.B. No. 907
 
  Substitute the following for H.B. No. 907:
 
  By:  Oliverson C.S.H.B. No. 907
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to prior authorization for prescription drug benefits
  related to the treatment of autoimmune diseases.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1369, Insurance Code, is amended by
  adding Subchapter L to read as follows:
  SUBCHAPTER L. COVERAGE OF PRESCRIPTION DRUGS FOR AUTOIMMUNE
  DISEASES
         Sec. 1369.551.  DEFINITION. In this subchapter,
  "prescription drug" has the meaning assigned by Section 551.003,
  Occupations Code.
         Sec. 1369.552.  APPLICABILITY OF SUBCHAPTER. (a) This
  subchapter applies only to a health benefit plan that provides
  benefits for medical, surgical, or prescription drug 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 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. 1369.553.  EXCEPTIONS. (a) This subchapter does not
  apply to:
               (1)  a plan that provides coverage:
                     (A)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (B)  as a supplement to a liability insurance
  policy;
                     (C)  for credit insurance;
                     (D)  only for dental or vision care;
                     (E)  only for hospital expenses; 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(g)(1));
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy; or
               (5)  a long-term care 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 1369.552.
         (b)  This subchapter does not apply to an individual health
  benefit plan issued on or before March 23, 2010, that has not had
  any significant changes since that date that reduce benefits or
  increase costs to the individual.
         Sec. 1369.554.  PROHIBITION ON MULTIPLE PRIOR
  AUTHORIZATIONS. A health benefit plan issuer that provides
  prescription drug benefits may not require an enrollee to receive
  more than one prior authorization annually of the prescription drug
  benefit for a prescription drug prescribed to treat an autoimmune
  disease.
         SECTION 2.  The change in law made by this Act applies only
  to a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2022.
         SECTION 3.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 4.  This Act takes effect September 1, 2021.
feedback