88R7294 KBB-F
 
  By: Harris of Anderson H.B. No. 1647
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit plan coverage of clinician-administered
  drugs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1369, Insurance Code, is amended by
  adding Subchapter Q to read as follows:
  SUBCHAPTER Q. CLINICIAN-ADMINISTERED DRUGS
         Sec. 1369.761.  DEFINITIONS. In this subchapter:
               (1)  "Administer" means to directly apply a drug to the
  body of a patient by injection, inhalation, ingestion, or any other
  means.
               (2)  "Clinician-administered drug" means an outpatient
  prescription drug other than a vaccine that:
                     (A)  cannot reasonably be:
                           (i)  self-administered by the patient to
  whom the drug is prescribed; or
                           (ii)  administered by an individual
  assisting the patient with the self-administration; and
                     (B)  is typically administered:
                           (i)  by a physician or other health care
  provider authorized under the laws of this state to administer the
  drug, including when acting under a physician's delegation and
  supervision; and
                           (ii)  in a physician's office, hospital
  outpatient infusion center, or other clinical setting.
               (3)  "Health care provider" means an individual who is
  licensed, certified, or otherwise authorized to provide health care
  services in this state.
               (4)  "Physician" means an individual licensed to
  practice medicine in this state.
         Sec. 1369.762.  APPLICABILITY OF SUBCHAPTER. (a) This
  subchapter applies only to a health benefit plan 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 health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this subchapter applies
  to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (4)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (5)  a regional or local health care program operating
  under Section 75.104, Health and Safety Code; and
               (6)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         Sec. 1369.763.  EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.  
  This subchapter does not apply to an issuer or provider of health
  benefits under or a pharmacy benefit manager administering pharmacy
  benefits under:
               (1)  the state Medicaid program, including the Medicaid
  managed care program under Chapter 533, Government Code;
               (2)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (3)  the TRICARE military health system; or
               (4)  a workers' compensation insurance policy or other
  form of providing medical benefits under Title 5, Labor Code.
         Sec. 1369.764.  CERTAIN LIMITATIONS ON COVERAGE OF
  CLINICIAN-ADMINISTERED DRUGS PROHIBITED. (a) A health benefit
  plan issuer may not, for an enrollee with a chronic, complex, rare,
  or life-threatening medical condition:
               (1)  require clinician-administered drugs to be
  dispensed only by certain pharmacies or only by pharmacies
  participating in the health benefit plan issuer's network;
               (2)  if a clinician-administered drug is otherwise
  covered, limit or exclude coverage for such drugs based on the
  enrollee's choice of pharmacy, or because the drug was not
  dispensed by a pharmacy that participates in the health benefit
  plan issuer's network;
               (3)  reimburse at a lesser amount
  clinician-administered drugs based on the enrollee's choice of
  pharmacy, or because the drug was dispensed by a pharmacy that does
  not participate in the health benefit plan issuer's network; or
               (4)  require that an enrollee pay an additional fee,
  higher copay, higher coinsurance, second copay, second
  coinsurance, or any other price increase for
  clinician-administered drugs based on the enrollee's choice of
  pharmacy, or because the drug was not dispensed by a pharmacy that
  participates in the health benefit plan issuer's network.
         (b)  Nothing in this section may be construed to:
               (1)  authorize a person to administer a drug when
  otherwise prohibited under the laws of this state or federal law; or
               (2)  modify drug administration requirements under the
  laws of this state, including any requirements related to
  delegation and supervision of drug administration.
         SECTION 2.  Subchapter Q, 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,
  2024.
         SECTION 3.  This Act takes effect September 1, 2023.