Bill Text: TX SB262 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to health benefit plan coverage for orally administered anticancer medications.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-04-29 - Co-author authorized [SB262 Detail]
Download: Texas-2011-SB262-Introduced.html
| 82R2426 RWG-D | ||
| By: Carona | S.B. No. 262 | |
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| 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. DEFINITION. In this subchapter, "enrollee" | ||
| means an individual entitled to coverage under a health benefit | ||
| plan. | ||
| Sec. 1369.202. APPLICABILITY OF SUBCHAPTER. (a) 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; | ||
| (8) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (9) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) Notwithstanding any provision in Chapter 1551, 1575, | ||
| 1579, or 1601 or any other law, this subchapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) basic coverage under Chapter 1601. | ||
| Sec. 1369.203. EXCEPTION. 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; or | ||
| (7) 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 1369.202. | ||
| 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 patient's out-of-pocket costs may not | ||
| be greater than the out-of-pocket costs for an intravenously | ||
| administered anticancer medication. | ||
| (c) Before a health benefit plan issuer increases patients' | ||
| out-of-pocket costs for intravenously administered anticancer | ||
| medications under the plan, the plan issuer must file the proposed | ||
| increase with the department with evidence that shows the proposed | ||
| increase is directly related to and necessitated by an increase in | ||
| costs to the plan for intravenous medication. The commissioner may | ||
| deny the proposed increase if the plan issuer does not make the | ||
| showing required by this subsection. A proposed increase may not | ||
| violate Subsection (a) or (b). If the commissioner does not deny | ||
| the proposed increase before the 61st day after the date the | ||
| proposed increase is filed with the department, the proposed | ||
| increase is considered approved, and subject to Subsections (a) and | ||
| (b), the plan issuer may implement the proposed increase. | ||
| 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. | ||
