| 1 | 1 | | 89R11882 SCF-D |
|---|
| 2 | 2 | | By: Bucy H.B. No. 2412 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | |
|---|
| 6 | 6 | | |
|---|
| 7 | 7 | | A BILL TO BE ENTITLED |
|---|
| 8 | 8 | | AN ACT |
|---|
| 9 | 9 | | relating to health benefit plan coverage for certain obesity |
|---|
| 10 | 10 | | medications. |
|---|
| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 12 | 12 | | SECTION 1. Chapter 1369, Insurance Code, is amended by |
|---|
| 13 | 13 | | adding Subchapter R to read as follows: |
|---|
| 14 | 14 | | SUBCHAPTER R. COVERAGE FOR CERTAIN OBESITY MEDICATIONS |
|---|
| 15 | 15 | | Sec. 1369.781. APPLICABILITY OF SUBCHAPTER. (a) This |
|---|
| 16 | 16 | | subchapter applies only to a health benefit plan that provides |
|---|
| 17 | 17 | | benefits for medical or surgical expenses incurred as a result of a |
|---|
| 18 | 18 | | health condition, accident, or sickness, including an individual, |
|---|
| 19 | 19 | | group, blanket, or franchise insurance policy or insurance |
|---|
| 20 | 20 | | agreement, a group hospital service contract, or an individual or |
|---|
| 21 | 21 | | group evidence of coverage or similar coverage document that is |
|---|
| 22 | 22 | | issued by: |
|---|
| 23 | 23 | | (1) an insurance company; |
|---|
| 24 | 24 | | (2) a group hospital service corporation operating |
|---|
| 25 | 25 | | under Chapter 842; |
|---|
| 26 | 26 | | (3) a health maintenance organization operating under |
|---|
| 27 | 27 | | Chapter 843; |
|---|
| 28 | 28 | | (4) an approved nonprofit health corporation that |
|---|
| 29 | 29 | | holds a certificate of authority under Chapter 844; |
|---|
| 30 | 30 | | (5) a multiple employer welfare arrangement that holds |
|---|
| 31 | 31 | | a certificate of authority under Chapter 846; |
|---|
| 32 | 32 | | (6) a stipulated premium company operating under |
|---|
| 33 | 33 | | Chapter 884; |
|---|
| 34 | 34 | | (7) a fraternal benefit society operating under |
|---|
| 35 | 35 | | Chapter 885; |
|---|
| 36 | 36 | | (8) a Lloyd's plan operating under Chapter 941; or |
|---|
| 37 | 37 | | (9) an exchange operating under Chapter 942. |
|---|
| 38 | 38 | | (b) Notwithstanding any other law, this subchapter applies |
|---|
| 39 | 39 | | to: |
|---|
| 40 | 40 | | (1) a basic coverage plan under Chapter 1551; |
|---|
| 41 | 41 | | (2) a basic plan under Chapter 1575; |
|---|
| 42 | 42 | | (3) a primary care coverage plan under Chapter 1579; |
|---|
| 43 | 43 | | and |
|---|
| 44 | 44 | | (4) the state Medicaid program, including the Medicaid |
|---|
| 45 | 45 | | managed care program operated under Chapter 540, Government Code. |
|---|
| 46 | 46 | | Sec. 1369.782. COVERAGE REQUIRED FOR CERTAIN OBESITY |
|---|
| 47 | 47 | | MEDICATIONS. A health benefit plan that provides prescription drug |
|---|
| 48 | 48 | | benefits must provide coverage for a prescription drug that is a |
|---|
| 49 | 49 | | glucagon-like peptide-1 receptor agonist to treat obesity. |
|---|
| 50 | 50 | | SECTION 2. If before implementing any provision of this Act |
|---|
| 51 | 51 | | a state agency determines that a waiver or authorization from a |
|---|
| 52 | 52 | | federal agency is necessary for implementation of that provision, |
|---|
| 53 | 53 | | the agency affected by the provision shall request the waiver or |
|---|
| 54 | 54 | | authorization and may delay implementing that provision until the |
|---|
| 55 | 55 | | waiver or authorization is granted. |
|---|
| 56 | 56 | | SECTION 3. Subchapter R, Chapter 1369, Insurance Code, as |
|---|
| 57 | 57 | | added by this Act, applies only to a health benefit plan delivered, |
|---|
| 58 | 58 | | issued for delivery, or renewed on or after January 1, 2026. |
|---|
| 59 | 59 | | SECTION 4. This Act takes effect September 1, 2025. |
|---|