By: Hull, et al. (Senate Sponsor - Menéndez) H.B. No. 1337
         (In the Senate - Received from the House April 12, 2023;
  April 13, 2023, read first time and referred to Committee on Health &
  Human Services; May 19, 2023, reported favorably by the following
  vote:  Yeas 8, Nays 0; May 19, 2023, sent to printer.)
Click here to see the committee vote
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to step therapy protocols required by health benefit plans
  for coverage of prescription drugs for serious mental illnesses.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 1369, Insurance Code, is
  amended by adding Section 1369.0547 to read as follows:
         Sec. 1369.0547.  STEP THERAPY PROTOCOLS FOR PRESCRIPTION
  DRUGS TO TREAT SERIOUS MENTAL ILLNESSES.  (a)  In this section,
  "serious mental illness" has the meaning assigned by Section
  1355.001.
         (b)  This section applies only to a drug prescribed to an
  enrollee who is 18 years of age or older to treat a diagnosis of a
  serious mental illness.
         (c)  A health benefit plan that provides coverage for
  prescription drugs to treat a serious mental illness may not
  require, before the health benefit plan provides coverage of a
  prescription drug approved by the United States Food and Drug
  Administration, that the enrollee:
               (1)  fail to successfully respond to more than one
  different drug for each drug prescribed, excluding the generic or
  pharmaceutical equivalent of the prescribed drug; or
               (2)  prove a history of failure of more than one
  different drug for each drug prescribed, excluding the generic or
  pharmaceutical equivalent of the prescribed drug.
         (d)  Subject to Section 1369.0546, a health benefit plan
  issuer may implement a step therapy protocol to require a trial of a
  generic or pharmaceutical equivalent of a prescribed prescription
  drug as a condition of continued coverage of the prescribed drug
  only:
               (1)  once in a plan year; and
               (2)  if the generic or pharmaceutical equivalent drug
  is added to the plan's drug formulary.
         SECTION 2.  This Act applies only to a health benefit plan
  delivered, issued for delivery, or renewed on or after January 1,
  2024. A health benefit plan delivered, issued for delivery, or
  renewed before January 1, 2024, is governed by the law as it existed
  immediately before the effective date of this Act, and that law is
  continued in effect for that purpose.
         SECTION 3.  This Act takes effect September 1, 2023.
 
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