| 1 | 1 | | 88R2329 CJD-D |
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| 2 | 2 | | By: Menéndez S.B. No. 1150 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to prior authorization for prescription drug benefits |
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| 8 | 8 | | related to the treatment of chronic and autoimmune diseases. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Chapter 1369, Insurance Code, is amended by |
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| 11 | 11 | | adding Subchapter N to read as follows: |
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| 12 | 12 | | SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC AND |
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| 13 | 13 | | AUTOIMMUNE DISEASES |
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| 14 | 14 | | Sec. 1369.651. DEFINITION. In this subchapter, |
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| 15 | 15 | | "prescription drug" has the meaning assigned by Section 551.003, |
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| 16 | 16 | | Occupations Code. |
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| 17 | 17 | | Sec. 1369.652. APPLICABILITY OF SUBCHAPTER. (a) This |
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| 18 | 18 | | subchapter applies only to a health benefit plan that provides |
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| 19 | 19 | | benefits for medical, surgical, or prescription drug expenses |
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| 20 | 20 | | incurred as a result of a health condition, accident, or sickness, |
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| 21 | 21 | | including an individual, group, blanket, or franchise insurance |
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| 22 | 22 | | policy or insurance agreement, a group hospital service contract, |
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| 23 | 23 | | or an individual or group evidence of coverage or similar coverage |
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| 24 | 24 | | document that is issued by: |
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| 25 | 25 | | (1) an insurance company; |
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| 26 | 26 | | (2) a group hospital service corporation operating |
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| 27 | 27 | | under Chapter 842; |
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| 28 | 28 | | (3) a health maintenance organization operating under |
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| 29 | 29 | | Chapter 843; |
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| 30 | 30 | | (4) an approved nonprofit health corporation that |
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| 31 | 31 | | holds a certificate of authority under Chapter 844; |
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| 32 | 32 | | (5) a multiple employer welfare arrangement that holds |
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| 33 | 33 | | a certificate of authority under Chapter 846; |
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| 34 | 34 | | (6) a stipulated premium company operating under |
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| 35 | 35 | | Chapter 884; |
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| 36 | 36 | | (7) a fraternal benefit society operating under |
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| 37 | 37 | | Chapter 885; |
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| 38 | 38 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 39 | 39 | | (9) an exchange operating under Chapter 942. |
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| 40 | 40 | | (b) Notwithstanding any other law, this subchapter applies |
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| 41 | 41 | | to: |
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| 42 | 42 | | (1) a small employer health benefit plan subject to |
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| 43 | 43 | | Chapter 1501, including coverage provided through a health group |
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| 44 | 44 | | cooperative under Subchapter B of that chapter; |
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| 45 | 45 | | (2) a standard health benefit plan issued under |
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| 46 | 46 | | Chapter 1507; |
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| 47 | 47 | | (3) a basic coverage plan under Chapter 1551; |
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| 48 | 48 | | (4) a basic plan under Chapter 1575; |
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| 49 | 49 | | (5) a primary care coverage plan under Chapter 1579; |
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| 50 | 50 | | (6) a plan providing basic coverage under Chapter |
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| 51 | 51 | | 1601; |
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| 52 | 52 | | (7) health benefits provided by or through a church |
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| 53 | 53 | | benefits board under Subchapter I, Chapter 22, Business |
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| 54 | 54 | | Organizations Code; |
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| 55 | 55 | | (8) group health coverage made available by a school |
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| 56 | 56 | | district in accordance with Section 22.004, Education Code; |
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| 57 | 57 | | (9) a regional or local health care program operated |
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| 58 | 58 | | under Section 75.104, Health and Safety Code; and |
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| 59 | 59 | | (10) a self-funded health benefit plan sponsored by a |
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| 60 | 60 | | professional employer organization under Chapter 91, Labor Code. |
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| 61 | 61 | | (c) This subchapter applies to coverage under a group health |
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| 62 | 62 | | benefit plan provided to a resident of this state regardless of |
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| 63 | 63 | | whether the group policy, agreement, or contract is delivered, |
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| 64 | 64 | | issued for delivery, or renewed in this state. |
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| 65 | 65 | | Sec. 1369.653. EXCEPTIONS. (a) This subchapter does not |
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| 66 | 66 | | apply to a plan that provides coverage: |
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| 67 | 67 | | (1) for wages or payments in lieu of wages for a period |
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| 68 | 68 | | during which an employee is absent from work because of sickness or |
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| 69 | 69 | | injury; or |
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| 70 | 70 | | (2) only for hospital expenses. |
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| 71 | 71 | | (b) This subchapter does not apply to an individual health |
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| 72 | 72 | | benefit plan issued on or before March 23, 2010, that has not had |
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| 73 | 73 | | any significant changes since that date that reduce benefits or |
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| 74 | 74 | | increase costs to the individual. |
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| 75 | 75 | | Sec. 1369.654. PROHIBITION ON MULTIPLE PRIOR |
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| 76 | 76 | | AUTHORIZATIONS. A health benefit plan issuer that provides |
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| 77 | 77 | | prescription drug benefits may not require an enrollee to receive |
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| 78 | 78 | | more than one prior authorization annually of the prescription drug |
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| 79 | 79 | | benefit for a prescription drug prescribed to treat a chronic or |
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| 80 | 80 | | autoimmune disease. |
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| 81 | 81 | | SECTION 2. The change in law made by this Act applies only |
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| 82 | 82 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 83 | 83 | | renewed on or after January 1, 2024. |
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| 84 | 84 | | SECTION 3. This Act takes effect September 1, 2023. |
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