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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 of clinician-administered |
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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 L to read as follows: |
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SUBCHAPTER L. CLINICIAN-ADMINISTERED DRUGS |
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Sec. 1369.551. DEFINITIONS. In this subchapter: |
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(1) "Administer" means to directly apply a drug to the |
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body of a patient by injection, inhalation, ingestion, or any other |
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means. |
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(2) "Clinician-administered drug" means an outpatient |
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prescription drug other than a vaccine that: |
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(A) cannot reasonably be: |
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(i) self-administered by the patient to |
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whom the drug is prescribed; or |
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(ii) administered by an individual |
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assisting the patient with the self-administration; and |
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(B) is typically administered: |
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(i) by a physician or other health care |
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provider authorized under the laws of this state to administer the |
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drug, including when acting under a physician's delegation and |
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supervision; and |
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(ii) in a physician's office, hospital |
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outpatient infusion center, or other clinical setting. |
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(3) "Health care provider" means an individual who is |
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licensed, certified, or otherwise authorized to provide health care |
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services in this state. |
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(4) "Physician" means an individual licensed to |
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practice medicine in this state. |
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Sec. 1369.552. 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 health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(4) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(5) a regional or local health care program operating |
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under Section 75.104, Health and Safety Code; and |
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(6) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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(c) This subchapter does not apply to an issuer or provider |
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of health benefits under or a pharmacy benefit manager |
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administering pharmacy benefits under a workers' compensation |
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insurance policy or other form of providing medical benefits under |
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Title 5, Labor Code. |
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Sec. 1369.553. CERTAIN LIMITATIONS ON COVERAGE OF |
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CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit |
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plan issuer may not, for a patient with a cancer or cancer-related |
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diagnosis: |
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(1) require a clinician-administered drug to be |
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dispensed by a pharmacy; or |
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(2) require that a clinician-administered drug or the |
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administration of a clinician-administered drug be covered as a |
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pharmacy benefit rather than a medical benefit. |
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(b) Nothing in this section may be construed to: |
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(1) authorize a person to administer a drug when |
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otherwise prohibited under the laws of this state or federal law; or |
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(2) modify drug administration requirements under the |
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laws of this state, including any requirements related to |
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delegation and supervision of drug administration. |
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SECTION 2. Subchapter L, 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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2022. |
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SECTION 3. This Act takes effect September 1, 2021. |