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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for abuse-deterrent opioid |
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analgesic drugs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1369, Insurance Code, is amended by |
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adding Subchapter J to read as follows: |
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SUBCHAPTER J. COVERAGE FOR ABUSE-DETERRENT OPIOID ANALGESIC DRUGS |
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Sec. 1369.451. DEFINITIONS. In this subchapter: |
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(1) "Abuse-deterrent opioid analgesic drug" means an |
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opioid analgesic drug that the United States Food and Drug |
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Administration has approved and for which the United States Food |
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and Drug Administration has approved abuse-deterrence labeling |
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that indicates the drug is expected to result in a meaningful |
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reduction in abuse. |
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(2) "Opioid analgesic drug" means a drug in the opioid |
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analgesic drug class that: |
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(A) is prescribed to treat moderate to severe |
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pain or other conditions; and |
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(B) may be: |
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(i) in an immediate-release or |
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extended-release form of the drug; |
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(ii) a single component drug; or |
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(iii) in combination with another drug. |
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Sec. 1369.452. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) a reciprocal exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) Notwithstanding Section 1501.251 or any other law, this |
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subchapter applies to a small employer health benefit plan subject |
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to Chapter 1501. |
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(c) Notwithstanding any other law, a standard health |
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benefit plan provided under Chapter 1507 must provide the coverage |
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required by this subchapter. |
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Sec. 1369.453. EXCEPTIONS. (a) This subchapter does not |
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apply to: |
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(1) a health benefit plan that provides coverage only: |
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(A) for a specified disease or for another |
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limited benefit other than for cancer; |
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(B) for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; |
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(E) for credit insurance; |
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(F) for dental or vision care; or |
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(G) for indemnity for hospital confinement; |
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(2) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(5) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a health benefit plan as described |
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by Section 1369.452. |
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(b) This subchapter does not apply to: |
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(1) the Medicaid managed care program operated under |
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Chapter 533, Government Code; |
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(2) the Medicaid program operated under Chapter 32, |
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Human Resources Code; or |
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(3) the child health plan program operated under |
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Chapter 62, Health and Safety Code. |
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Sec. 1369.454. REQUIRED COVERAGE FOR ABUSE-DETERRENT |
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OPIOID ANALGESIC DRUGS. (a) A health benefit plan must provide |
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coverage for abuse-deterrent opioid analgesic drugs. |
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(b) A health benefit plan issuer may not reduce or limit a |
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payment to a health care professional, or otherwise penalize the |
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professional, because the professional prescribes or dispenses an |
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abuse-deterrent opioid analgesic drug. |
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Sec. 1369.455. PRIOR AUTHORIZATION. (a) A health benefit |
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plan may require prior authorization for an abuse-deterrent opioid |
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analgesic drug in the same manner that the health benefit plan |
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requires prior authorization for an opioid analgesic drug that does |
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not have abuse-deterrent properties. |
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(b) A health benefit plan may not require an enrollee to use |
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an opioid analgesic drug that does not have abuse-deterrent |
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properties before prior authorization for an abuse-deterrent |
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opioid analgesic drug may be given. |
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SECTION 2. Subchapter J, Chapter 1369, Insurance Code, as |
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added by this Act, applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed on or after January 1, |
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2018. A health benefit plan that is delivered, issued for delivery, |
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or renewed before January 1, 2018, is covered by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2017. |