| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to prior authorization for prescription drug benefits |
|
|
related to the treatment of chronic health conditions. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. The heading to Subchapter N, Chapter 1369, |
|
|
Insurance Code, is amended to read as follows: |
|
|
SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC HEALTH |
|
|
CONDITIONS [AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS] |
|
|
SECTION 2. Section 1369.651, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1369.651. DEFINITIONS [DEFINITION]. In this |
|
|
subchapter: |
|
|
(1) "Chronic health condition" means an illness, |
|
|
injury, impairment, or physical or mental condition that is |
|
|
expected to last at least one year and either: |
|
|
(A) requires ongoing medical attention to |
|
|
effectively manage or to prevent an adverse health event; or |
|
|
(B) limits one or more of the following |
|
|
activities of daily living: |
|
|
(i) bathing; |
|
|
(ii) personal hygiene; |
|
|
(iii) eating; |
|
|
(iv) toileting; |
|
|
(v) dressing; |
|
|
(vi) bed mobility; or |
|
|
(vii) walking or locomotion. |
|
|
(2) "Prescription [, "prescription] drug" has the |
|
|
meaning assigned by Section 551.003, Occupations Code. |
|
|
SECTION 3. Section 1369.654(a), Insurance Code, is amended |
|
|
to read as follows: |
|
|
(a) A health benefit plan issuer that provides prescription |
|
|
drug benefits may not require an enrollee to receive more than one |
|
|
prior authorization annually of the prescription drug benefit for a |
|
|
prescription drug prescribed to treat a chronic health condition, |
|
|
including an autoimmune disease, hemophilia, neurodegenerative |
|
|
disease, or Von Willebrand disease. |
|
|
SECTION 4. The change in law made by this Act applies only |
|
|
to a health benefit plan that is delivered, issued for delivery, or |
|
|
renewed on or after January 1, 2026. A health benefit plan |
|
|
delivered, issued for delivery, or renewed before January 1, 2026, |
|
|
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 5. This Act takes effect September 1, 2025. |