| 1 | 1 | | H.B. No. 1337 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | AN ACT |
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| 5 | 5 | | relating to step therapy protocols required by health benefit plans |
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| 6 | 6 | | for coverage of prescription drugs for serious mental illnesses. |
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| 7 | 7 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 8 | 8 | | SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is |
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| 9 | 9 | | amended by adding Section 1369.0547 to read as follows: |
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| 10 | 10 | | Sec. 1369.0547. STEP THERAPY PROTOCOLS FOR PRESCRIPTION |
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| 11 | 11 | | DRUGS TO TREAT SERIOUS MENTAL ILLNESSES. (a) In this section, |
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| 12 | 12 | | "serious mental illness" has the meaning assigned by Section |
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| 13 | 13 | | 1355.001. |
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| 14 | 14 | | (b) This section applies only to a drug prescribed to an |
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| 15 | 15 | | enrollee who is 18 years of age or older to treat a diagnosis of a |
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| 16 | 16 | | serious mental illness. |
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| 17 | 17 | | (c) A health benefit plan that provides coverage for |
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| 18 | 18 | | prescription drugs to treat a serious mental illness may not |
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| 19 | 19 | | require, before the health benefit plan provides coverage of a |
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| 20 | 20 | | prescription drug approved by the United States Food and Drug |
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| 21 | 21 | | Administration, that the enrollee: |
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| 22 | 22 | | (1) fail to successfully respond to more than one |
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| 23 | 23 | | different drug for each drug prescribed, excluding the generic or |
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| 24 | 24 | | pharmaceutical equivalent of the prescribed drug; or |
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| 25 | 25 | | (2) prove a history of failure of more than one |
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| 26 | 26 | | different drug for each drug prescribed, excluding the generic or |
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| 27 | 27 | | pharmaceutical equivalent of the prescribed drug. |
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| 28 | 28 | | (d) Subject to Section 1369.0546, a health benefit plan |
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| 29 | 29 | | issuer may implement a step therapy protocol to require a trial of a |
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| 30 | 30 | | generic or pharmaceutical equivalent of a prescribed prescription |
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| 31 | 31 | | drug as a condition of continued coverage of the prescribed drug |
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| 32 | 32 | | only: |
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| 33 | 33 | | (1) once in a plan year; and |
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| 34 | 34 | | (2) if the generic or pharmaceutical equivalent drug |
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| 35 | 35 | | is added to the plan's drug formulary. |
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| 36 | 36 | | SECTION 2. This Act applies only to a health benefit plan |
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| 37 | 37 | | delivered, issued for delivery, or renewed on or after January 1, |
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| 38 | 38 | | 2024. A health benefit plan delivered, issued for delivery, or |
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| 39 | 39 | | renewed before January 1, 2024, is governed by the law as it existed |
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| 40 | 40 | | immediately before the effective date of this Act, and that law is |
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| 41 | 41 | | continued in effect for that purpose. |
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| 42 | 42 | | SECTION 3. This Act takes effect September 1, 2023. |
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| 43 | 43 | | ______________________________ ______________________________ |
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| 44 | 44 | | President of the Senate Speaker of the House |
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| 45 | 45 | | I certify that H.B. No. 1337 was passed by the House on April |
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| 46 | 46 | | 12, 2023, by the following vote: Yeas 146, Nays 1, 2 present, not |
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| 47 | 47 | | voting. |
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| 48 | 48 | | ______________________________ |
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| 49 | 49 | | Chief Clerk of the House |
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| 50 | 50 | | I certify that H.B. No. 1337 was passed by the Senate on May |
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| 51 | 51 | | 23, 2023, by the following vote: Yeas 31, Nays 0. |
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| 52 | 52 | | ______________________________ |
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| 53 | 53 | | Secretary of the Senate |
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| 54 | 54 | | APPROVED: _____________________ |
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| 55 | 55 | | Date |
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| 56 | 56 | | _____________________ |
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| 57 | 57 | | Governor |
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