Texas House Bill HB3542

Texas 2025 - 89th Regular

• Filed: 2/28/25

Caption

Relating to the effect of a pharmacy benefit manager change on prescription drug coverage.

Impact

The introduction of HB3542 seeks to provide greater protection for consumers against potential negative effects caused by changes in pharmacy benefit managers. It is expected that by mandating uninterrupted prescription drug coverage regardless of administrative shifts, the bill will contribute to better health outcomes and lessen the burden on patients who might otherwise face challenges related to accessing necessary medications. This change is particularly significant given the complexities and changing nature of health insurance offerings.

Summary

House Bill 3542 addresses the implications of changes concerning pharmacy benefit managers (PBM) on the coverage of prescription drugs for enrollees in various health benefit plans. The legislation stipulates that a health benefit plan cannot deny or restrict an enrollee's access to a prescription medication solely due to a shift in the plan's pharmacy benefit management. This measure intends to ensure continuity of care and reduce disruptions for patients who rely on specific medications that may be impacted by administrative changes within their health coverage provider.

Contention

Although the intent of HB3542 is largely seen as beneficial to patient care, there may be concerns regarding the potential for increased costs to health benefit providers, which could arise from mandatory coverage in the face of administrative changes. Proponents of the bill argue that ensuring consistent access to medications is a critical aspect of healthcare; however, some opponents might question the financial implications on insurance premiums and how this could affect the overall affordability of health plans in the market. Additionally, the implementation of these provisions will depend on the ability of both state and federal agencies to manage necessary waivers before full enactment.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1369. Benefits Related To Prescription Drugs And Devices And Related Services
  • Section: New Section