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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 for certain obesity |
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medications. |
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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 R to read as follows: |
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SUBCHAPTER R. COVERAGE FOR CERTAIN OBESITY MEDICATIONS |
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Sec. 1369.781. 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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issued 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 basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 540, Government Code. |
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Sec. 1369.782. COVERAGE REQUIRED FOR CERTAIN OBESITY |
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MEDICATIONS. A health benefit plan that provides prescription drug |
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benefits must provide coverage for a prescription drug that is a |
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glucagon-like peptide-1 receptor agonist to treat obesity. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. Subchapter R, Chapter 1369, Insurance Code, as |
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added by this Act, applies only to a health benefit plan delivered, |
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issued for delivery, or renewed on or after January 1, 2026. |
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SECTION 4. This Act takes effect September 1, 2025. |