| 1 | 1 | | 89R4580 DNC-D |
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| 2 | 2 | | By: Jones of Dallas H.B. No. 2557 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to prior authorization for prescription drug benefits |
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| 10 | 10 | | related to the treatment of chronic health conditions. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. The heading to Subchapter N, Chapter 1369, |
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| 13 | 13 | | Insurance Code, is amended to read as follows: |
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| 14 | 14 | | SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC HEALTH |
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| 15 | 15 | | CONDITIONS [AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS] |
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| 16 | 16 | | SECTION 2. Section 1369.651, Insurance Code, is amended to |
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| 17 | 17 | | read as follows: |
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| 18 | 18 | | Sec. 1369.651. DEFINITIONS [DEFINITION]. In this |
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| 19 | 19 | | subchapter: |
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| 20 | 20 | | (1) "Chronic health condition" means an illness, |
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| 21 | 21 | | injury, impairment, or physical or mental condition that is |
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| 22 | 22 | | expected to last at least one year and either: |
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| 23 | 23 | | (A) requires ongoing medical attention to |
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| 24 | 24 | | effectively manage or to prevent an adverse health event; or |
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| 25 | 25 | | (B) limits one or more of the following |
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| 26 | 26 | | activities of daily living: |
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| 27 | 27 | | (i) bathing; |
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| 28 | 28 | | (ii) personal hygiene; |
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| 29 | 29 | | (iii) eating; |
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| 30 | 30 | | (iv) toileting; |
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| 31 | 31 | | (v) dressing; |
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| 32 | 32 | | (vi) bed mobility; or |
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| 33 | 33 | | (vii) walking or locomotion. |
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| 34 | 34 | | (2) "Prescription [, "prescription] drug" has the |
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| 35 | 35 | | meaning assigned by Section 551.003, Occupations Code. |
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| 36 | 36 | | SECTION 3. Section 1369.654(a), Insurance Code, is amended |
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| 37 | 37 | | to read as follows: |
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| 38 | 38 | | (a) A health benefit plan issuer that provides prescription |
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| 39 | 39 | | drug benefits may not require an enrollee to receive more than one |
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| 40 | 40 | | prior authorization annually of the prescription drug benefit for a |
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| 41 | 41 | | prescription drug prescribed to treat a chronic health condition, |
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| 42 | 42 | | including an autoimmune disease, hemophilia, neurodegenerative |
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| 43 | 43 | | disease, or Von Willebrand disease. |
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| 44 | 44 | | SECTION 4. The change in law made by this Act applies only |
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| 45 | 45 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 46 | 46 | | renewed on or after January 1, 2026. A health benefit plan |
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| 47 | 47 | | delivered, issued for delivery, or renewed before January 1, 2026, |
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| 48 | 48 | | is governed by the law as it existed immediately before the |
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| 49 | 49 | | effective date of this Act, and that law is continued in effect for |
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| 50 | 50 | | that purpose. |
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| 51 | 51 | | SECTION 5. This Act takes effect September 1, 2025. |
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