Vote Smart's Synopsis:

Vote to concur with senate amendments and pass a bill that repeals step therapy or "fail first" protocols for metastatic stage 4 cancer patients.

Highlights:

• Prohibits a health benefit plan that provides coverage for stage-four advanced, metastatic cancer and associated conditions from requiring the enrollee to fail in successfully responding to a different drug, or prove a history of failure of a different drug (Sec. 1).

• Defines “associated conditions” as the symptoms or side effects associated with stage-four advanced, metastatic cancer or its treatment and which, in the judgment of the health care practitioner, further jeopardize the health of a patient if left untreated (Sec. 1).

• Specifies that this section only applies to a drug that is (Sec. 1):

• Consistent with best practices for the treatment of stage-four advanced, metastatic cancer or an associated condition;

• Supported by peer-reviewed, evidence-based literature; and

• Approved by the United States Food and Drug Administration.

• Specifies that the following provisions only apply to a health benefit plan providing benefits for medical or surgical expenses or pharmacy benefits incurred from a health condition, accident, or sickness, including (Sec. 1):

• An individual, group, blanket, or franchise insurance policy or agreement;

• A group hospital service contract; or

• An individual or group evidence of coverage, or similar coverage document issued by:

• An insurance company;

• A group hospital service corporation;

• A health maintenance organization;

• An approved non-profit health corporation holding a certificate of authority;

• A multiple employer welfare arrangement holding a certificate of authority;

• A stipulated premium company;

• A fraternal benefit society;

• A Lloyd’s plan; or

• An exchange operating under chapter 942.

• Species that the above-mentioned provisions apply to coverage under a group health benefit plan provided to a resident of this state regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed in Texas (Sec. 1).

• Specifies that this act only applies to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2020 (Sec. 2).

Full Bill Text