Texas 2023 - 88th Regular

Texas House Bill HB755 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 755
2	2
3	3
4	4	AN ACT
5	5	relating to prior authorization for prescription drug benefits
6	6	related to the treatment of autoimmune diseases and certain blood
7	7	disorders.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Chapter 1369, Insurance Code, is amended by
10	10	adding Subchapter N to read as follows:
11	11	SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR AUTOIMMUNE
12	12	DISEASES AND CERTAIN BLOOD DISORDERS
13	13	Sec. 1369.651. DEFINITION. In this subchapter,
14	14	"prescription drug" has the meaning assigned by Section 551.003,
15	15	Occupations Code.
16	16	Sec. 1369.652. APPLICABILITY OF SUBCHAPTER. (a) This
17	17	subchapter applies only to a health benefit plan that provides
18	18	benefits for medical, surgical, or prescription drug expenses
19	19	incurred as a result of a health condition, accident, or sickness,
20	20	including an individual, group, blanket, or franchise insurance
21	21	policy or insurance agreement, a group hospital service contract,
22	22	or an individual or group evidence of coverage or similar coverage
23	23	document that is issued by:
24	24	(1) an insurance company;
25	25	(2) a group hospital service corporation operating
26	26	under Chapter 842;
27	27	(3) a health maintenance organization operating under
28	28	Chapter 843;
29	29	(4) an approved nonprofit health corporation that
30	30	holds a certificate of authority under Chapter 844;
31	31	(5) a multiple employer welfare arrangement that holds
32	32	a certificate of authority under Chapter 846;
33	33	(6) a stipulated premium company operating under
34	34	Chapter 884;
35	35	(7) a fraternal benefit society operating under
36	36	Chapter 885;
37	37	(8) a Lloyd's plan operating under Chapter 941; or
38	38	(9) an exchange operating under Chapter 942.
39	39	(b) Notwithstanding any other law, this subchapter applies
40	40	to:
41	41	(1) a small employer health benefit plan subject to
42	42	Chapter 1501, including coverage provided through a health group
43	43	cooperative under Subchapter B of that chapter;
44	44	(2) a standard health benefit plan issued under
45	45	Chapter 1507;
46	46	(3) a basic coverage plan under Chapter 1551;
47	47	(4) a basic plan under Chapter 1575;
48	48	(5) a primary care coverage plan under Chapter 1579;
49	49	(6) a plan providing basic coverage under Chapter
50	50	1601;
51	51	(7) group health coverage made available by a school
52	52	district in accordance with Section 22.004, Education Code; and
53	53	(8) a self-funded health benefit plan sponsored by a
54	54	professional employer organization under Chapter 91, Labor Code.
55	55	(c) This subchapter applies to coverage under a group health
56	56	benefit plan provided to a resident of this state regardless of
57	57	whether the group policy, agreement, or contract is delivered,
58	58	issued for delivery, or renewed in this state.
59	59	Sec. 1369.653. EXCEPTIONS. (a) This subchapter does not
60	60	apply to:
61	61	(1) a plan that provides coverage:
62	62	(A) for wages or payments in lieu of wages for a
63	63	period during which an employee is absent from work because of
64	64	sickness or injury; or
65	65	(B) only for hospital expenses;
66	66	(2) the state Medicaid program, including the Medicaid
67	67	managed care program operated under Chapter 533, Government Code;
68	68	or
69	69	(3) the child health plan program under Chapter 62,
70	70	Health and Safety Code.
71	71	(b) This subchapter does not apply to an individual health
72	72	benefit plan issued on or before March 23, 2010, that has not had
73	73	any significant changes since that date that reduce benefits or
74	74	increase costs to the individual.
75	75	Sec. 1369.654. PROHIBITION ON MULTIPLE PRIOR
76	76	AUTHORIZATIONS. (a) A health benefit plan issuer that provides
77	77	prescription drug benefits may not require an enrollee to receive
78	78	more than one prior authorization annually of the prescription drug
79	79	benefit for a prescription drug prescribed to treat an autoimmune
80	80	disease, hemophilia, or Von Willebrand disease.
81	81	(b) This section does not apply to:
82	82	(1) opioids, benzodiazepines, barbiturates, or
83	83	carisoprodol;
84	84	(2) prescription drugs that have a typical treatment
85	85	period of less than 12 months;
86	86	(3) drugs that:
87	87	(A) have a boxed warning assigned by the United
88	88	States Food and Drug Administration for use; and
89	89	(B) must have specific provider assessment; or
90	90	(4) the use of a drug approved for use by the United
91	91	States Food and Drug Administration in a manner other than the
92	92	approved use.
93	93	SECTION 2. The change in law made by this Act applies only
94	94	to a health benefit plan that is delivered, issued for delivery, or
95	95	renewed on or after January 1, 2024.
96	96	SECTION 3. This Act takes effect September 1, 2023.
97	97	______________________________ ______________________________
98	98	President of the Senate Speaker of the House
99	99	I certify that H.B. No. 755 was passed by the House on May 2,
100	100	2023, by the following vote: Yeas 129, Nays 15, 3 present, not
101	101	voting.
102	102	______________________________
103	103	Chief Clerk of the House
104	104	I certify that H.B. No. 755 was passed by the Senate on May
105	105	22, 2023, by the following vote: Yeas 31, Nays 0.
106	106	______________________________
107	107	Secretary of the Senate
108	108	APPROVED: _____________________
109	109	Date
110	110	_____________________
111	111	Governor