84R18846 MEW-D
	By: Clardy	H.B. No. 2505
	Substitute the following for H.B. No. 2505:
	By:  Vo	C.S.H.B. No. 2505

	A BILL TO BE ENTITLED
	AN ACT
	relating to health benefit plan coverage for abuse-deterrent opioid
	analgesic drugs.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1369, Insurance Code, is amended by
	adding Subchapter H to read as follows:
	SUBCHAPTER H. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS
	Sec. 1369.351.  DEFINITIONS. In this subchapter:
	(1)  "Abuse-deterrent opioid analgesic drug" means an
	opioid analgesic drug that the United States Food and Drug
	Administration has approved and for which the United States Food
	and Drug Administration has approved abuse-deterrence labeling
	that indicates the drug is expected to result in a meaningful
	reduction in abuse.
	(2)  "Opioid analgesic drug" means a drug in the opioid
	analgesic drug class that:
	(A)  is prescribed to treat moderate to severe
	pain or other conditions; and
	(B)  may be:
	(i)  in an immediate-release or
	extended-release form of the drug;
	(ii)  a single component drug; or
	(iii)  in combination with another drug.
	Sec. 1369.352.  APPLICABILITY OF SUBCHAPTER. (a)  This
	subchapter applies only to a health benefit plan, including a small
	employer health benefit plan written under Chapter 1501, 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)  a reciprocal exchange operating under Chapter 942;
	(6)  a health maintenance organization operating under
	Chapter 843;
	(7)  a multiple employer welfare arrangement that holds
	a certificate of authority under Chapter 846; or
	(8)  an approved nonprofit health corporation that
	holds a certificate of authority under Chapter 844.
	(b)  Notwithstanding Section 1501.251 or any other law, this
	subchapter applies to a small employer health benefit plan subject
	to Chapter 1501.
	(c)  Notwithstanding Sections 1507.004 and 1507.053, or any
	other law, this subchapter applies to a consumer choice of benefits
	plan issued under Chapter 1507.
	Sec. 1369.353.  EXCEPTIONS; APPLICATION TO QUALIFIED HEALTH
	PLAN. (a)  This subchapter does not apply to:
	(1)  a health benefit plan that provides coverage only:
	(A)  for a specified disease or for another
	limited benefit other than for cancer;
	(B)  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)  for credit insurance;
	(F)  for dental or vision care; or
	(G)  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),
	as amended;
	(3)  a workers' compensation insurance policy;
	(4)  medical payment insurance coverage provided under
	a motor vehicle insurance policy; or
	(5)  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 1369.102.
	(b)  This subchapter does not apply to:
	(1)  a Medicaid managed care program operated under
	Chapter 533, Government Code;
	(2)  a Medicaid program operated under Chapter 32,
	Human Resources Code; or
	(3)  the state child health plan operated under Chapter
	62 or 63, Health and Safety Code.
	(c)  To the extent that providing coverage for
	abuse-deterrent opioid analgesic drugs under this section would
	otherwise require this state to make a payment under 42 U.S.C.
	Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by
	45 C.F.R. Section 155.20, is not required to provide a benefit for
	the drugs under this section that exceeds the specified essential
	health benefits required under 42 U.S.C. Section 18022(b).
	Sec. 1369.354.  REQUIRED COVERAGE FOR ABUSE-DETERRENT
	OPIOID ANALGESIC DRUGS. (a)  A health benefit plan must provide
	coverage for abuse-deterrent opioid analgesic drugs.
	(b)  A health benefit plan issuer may not reduce or limit a
	payment to a health care professional, or otherwise penalize the
	professional, because the professional prescribes or dispenses an
	abuse-deterrent opioid analgesic drug.
	(c)  Nothing in this section may be construed to authorize a
	health care professional to dispense a drug.
	Sec. 1369.355.  PRIOR AUTHORIZATION. (a)  A health benefit
	plan may require prior authorization for an abuse-deterrent opioid
	analgesic drug if the health benefit plan requires prior
	authorization for versions of the opioid analgesic drug that do not
	have abuse-deterrent properties.
	(b)  A health benefit plan may not require an enrollee to use
	an opioid analgesic drug that does not have abuse-deterrent
	properties before prior authorization for an abuse-deterrent
	opioid analgesic drug may be given.
	SECTION 2.  Subchapter H, 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,
	2016. A health benefit plan that is delivered, issued for delivery,
	or renewed before January 1, 2016, 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, 2015.