Bill Text: TX HB2985 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to prior authorization for prescription drug benefits related to the prevention of human immunodeficiency virus infections.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2023-04-18 - Withdrawn from schedule [HB2985 Detail]
Download: Texas-2023-HB2985-Introduced.html
88R12307 CJD-D | ||
By: Jones of Dallas | H.B. No. 2985 |
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relating to prior authorization for prescription drug benefits | ||
related to the prevention of human immunodeficiency virus | ||
infections. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
adding Subchapter P to read as follows: | ||
SUBCHAPTER P. COVERAGE OF PRESCRIPTION DRUGS FOR PREVENTING HUMAN | ||
IMMUNODEFICIENCY VIRUS INFECTION | ||
Sec. 1369.751. DEFINITION. In this subchapter, | ||
"prescription drug" has the meaning assigned by Section 551.003, | ||
Occupations Code. | ||
Sec. 1369.752. APPLICABILITY OF SUBCHAPTER. (a) This | ||
subchapter applies only to a health benefit plan that provides | ||
benefits for medical, surgical, or prescription drug expenses | ||
incurred as a result of a health condition, accident, or sickness, | ||
including an individual, group, blanket, or franchise insurance | ||
policy or insurance agreement, a group hospital service contract, | ||
or an individual or group evidence of coverage or similar coverage | ||
document that is issued by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a health maintenance organization operating under | ||
Chapter 843; | ||
(4) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844; | ||
(5) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; | ||
(6) a stipulated premium company operating under | ||
Chapter 884; | ||
(7) a fraternal benefit society operating under | ||
Chapter 885; | ||
(8) a Lloyd's plan operating under Chapter 941; or | ||
(9) an exchange operating under Chapter 942. | ||
(b) Notwithstanding any other law, this subchapter applies | ||
to: | ||
(1) a small employer health benefit plan subject to | ||
Chapter 1501, including coverage provided through a health group | ||
cooperative under Subchapter B of that chapter; | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507; | ||
(3) a basic coverage plan under Chapter 1551; | ||
(4) a basic plan under Chapter 1575; | ||
(5) a primary care coverage plan under Chapter 1579; | ||
(6) a plan providing basic coverage under Chapter | ||
1601; | ||
(7) health benefits provided by or through a church | ||
benefits board under Subchapter I, Chapter 22, Business | ||
Organizations Code; | ||
(8) the state Medicaid program, including the Medicaid | ||
managed care program operated under Chapter 533, Government Code; | ||
(9) the child health plan program under Chapter 62, | ||
Health and Safety Code; | ||
(10) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code; | ||
(11) county employee group health benefits provided | ||
under Chapter 157, Local Government Code; and | ||
(12) health and accident coverage provided by a risk | ||
pool created under Chapter 172, Local Government Code. | ||
(c) This subchapter applies to coverage under a group health | ||
benefit plan provided to a resident of this state regardless of | ||
whether the group policy, agreement, or contract is delivered, | ||
issued for delivery, or renewed in this state. | ||
Sec. 1369.753. EXCEPTION. This subchapter does not apply | ||
to an individual health benefit plan issued on or before March 23, | ||
2010, that has not had any significant changes since that date that | ||
reduce benefits or increase costs to the individual. | ||
Sec. 1369.754. PROHIBITION ON PRIOR AUTHORIZATION. A | ||
health benefit plan issuer that provides prescription drug benefits | ||
may not require an enrollee to receive a prior authorization of the | ||
prescription drug benefit for a prescription drug prescribed to | ||
prevent human immunodeficiency virus infection. | ||
SECTION 2. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for implementation of that provision, | ||
the agency affected by the provision shall request the waiver or | ||
authorization and may delay implementing that provision until the | ||
waiver or authorization is granted. | ||
SECTION 3. The changes in law made by this Act apply only to | ||
a health benefit plan delivered, issued for delivery, or renewed on | ||
or after January 1, 2024. | ||
SECTION 4. This Act takes effect September 1, 2023. |