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A BILL TO BE ENTITLED
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AN ACT
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relating to step therapy protocols required by health benefit plans |
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for coverage of prescription drugs for serious mental illnesses. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is |
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amended by adding Section 1369.0547 to read as follows: |
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Sec. 1369.0547. STEP THERAPY PROTOCOLS FOR PRESCRIPTION |
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DRUGS TO TREAT SERIOUS MENTAL ILLNESSES. (a) In this section, |
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"serious mental illness" has the meaning assigned by Section |
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1355.001. |
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(b) This section applies only to a drug prescribed to an |
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enrollee who is 18 years of age or older to treat a diagnosis of a |
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serious mental illness. |
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(c) A health benefit plan that provides coverage for |
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prescription drugs to treat a serious mental illness may not |
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require, before the health benefit plan provides coverage of a |
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prescription drug approved by the United States Food and Drug |
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Administration, that the enrollee: |
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(1) fail to successfully respond to more than one |
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different drug for each drug prescribed, excluding the generic or |
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pharmaceutical equivalent of the prescribed drug; or |
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(2) prove a history of failure of more than one |
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different drug for each drug prescribed, excluding the generic or |
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pharmaceutical equivalent of the prescribed drug. |
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(d) Subject to Section 1369.0546, a health benefit plan |
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issuer may implement a step therapy protocol to require a trial of a |
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generic or pharmaceutical equivalent of a prescribed prescription |
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drug as a condition of continued coverage of the prescribed drug |
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only: |
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(1) once in a plan year; and |
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(2) if the equivalent drug is added to the plan's drug |
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formulary. |
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SECTION 2. This Act applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2022. A health benefit plan delivered, issued for delivery, or |
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renewed before January 1, 2022, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2021. |