88R20676 CJD-D
By: Johnson of Dallas, Lalani, Harless, H.B. No. 755
Jones of Dallas
Substitute the following for H.B. No. 755:
By: Oliverson C.S.H.B. No. 755
A BILL TO BE ENTITLED
AN ACT
relating to prior authorization for prescription drug benefits
related to the treatment of autoimmune diseases and certain blood
disorders.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1369, Insurance Code, is amended by
adding Subchapter N to read as follows:
SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR AUTOIMMUNE
DISEASES AND CERTAIN BLOOD DISORDERS
Sec. 1369.651. DEFINITION. In this subchapter,
"prescription drug" has the meaning assigned by Section 551.003,
Occupations Code.
Sec. 1369.652. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical, surgical, or prescription drug expenses
incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or an individual or group evidence of coverage or similar coverage
document that is issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) group health coverage made available by a school
district in accordance with Section 22.004, Education Code; and
(8) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
(c) This subchapter applies to coverage under a group health
benefit plan provided to a resident of this state regardless of
whether the group policy, agreement, or contract is delivered,
issued for delivery, or renewed in this state.
Sec. 1369.653. EXCEPTIONS. (a) This subchapter does not
apply to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury; or
(B) only for hospital expenses;
(2) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
or
(3) the child health plan program under Chapter 62,
Health and Safety Code.
(b) This subchapter does not apply to an individual health
benefit plan issued on or before March 23, 2010, that has not had
any significant changes since that date that reduce benefits or
increase costs to the individual.
Sec. 1369.654. PROHIBITION ON MULTIPLE PRIOR
AUTHORIZATIONS. (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 an autoimmune
disease, hemophilia, or Von Willebrand disease.
(b) This section does not apply to:
(1) opioids, benzodiazepines, barbiturates, or
carisoprodol;
(2) prescription drugs that have a typical treatment
period of less than 12 months;
(3) drugs that:
(A) have a boxed warning assigned by the United
States Food and Drug Administration for use; and
(B) must have specific provider assessment; or
(4) the use of a drug approved for use by the United
States Food and Drug Administration in a manner other than the
approved use.
SECTION 2. 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, 2024.
SECTION 3. This Act takes effect September 1, 2023.