89R4580 DNC-D
By: Jones of Dallas H.B. No. 2557
A BILL TO BE ENTITLED
AN ACT
relating to prior authorization for prescription drug benefits
related to the treatment of chronic health conditions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subchapter N, Chapter 1369,
Insurance Code, is amended to read as follows:
SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC HEALTH
CONDITIONS [AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS]
SECTION 2. Section 1369.651, Insurance Code, is amended to
read as follows:
Sec. 1369.651. DEFINITIONS [DEFINITION]. In this
subchapter:
(1) "Chronic health condition" means an illness,
injury, impairment, or physical or mental condition that is
expected to last at least one year and either:
(A) requires ongoing medical attention to
effectively manage or to prevent an adverse health event; or
(B) limits one or more of the following
activities of daily living:
(i) bathing;
(ii) personal hygiene;
(iii) eating;
(iv) toileting;
(v) dressing;
(vi) bed mobility; or
(vii) walking or locomotion.
(2) "Prescription [, "prescription] drug" has the
meaning assigned by Section 551.003, Occupations Code.
SECTION 3. Section 1369.654(a), Insurance Code, is amended
to read as follows:
(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 a chronic health condition,
including an autoimmune disease, hemophilia, neurodegenerative
disease, or Von Willebrand disease.
SECTION 4. 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, 2026. A health benefit plan
delivered, issued for delivery, or renewed before January 1, 2026,
is governed by the law as it existed immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 5. This Act takes effect September 1, 2025.