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A BILL TO BE ENTITLED
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AN ACT
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relating to prior authorization for prescription drug benefits |
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related to the treatment of neurodegenerative diseases. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subchapter N, Chapter 1369, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR AUTOIMMUNE AND |
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NEURODEGENERATIVE DISEASES AND CERTAIN BLOOD DISORDERS |
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SECTION 2. Section 1369.654, Insurance Code, is amended by |
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amending Subsection (a) and adding Subsection (c) to read as |
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follows: |
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(a) A health benefit plan issuer that provides prescription |
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drug benefits may not require an enrollee to receive more than one |
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prior authorization annually of the prescription drug benefit for a |
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prescription drug prescribed to treat an autoimmune disease, a |
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neurodegenerative disease, hemophilia, or Von Willebrand disease. |
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(c) Notwithstanding Subsection (a), a health benefit plan |
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issuer may require an enrollee who is prescribed a new prescription |
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drug to treat a neurodegenerative disease to obtain a prior |
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authorization for the prescription drug. |
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SECTION 3. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2026. A health benefit plan |
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delivered, issued for delivery, or renewed before January 1, 2026, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 4. This Act takes effect September 1, 2025. |