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