Bill Text: TX HB755 | 2023-2024 | 88th Legislature | Enrolled
Bill Title: Relating to prior authorization for prescription drug benefits related to the treatment of autoimmune diseases and certain blood disorders.
Sponsorship: Moderate Partisan Bill (Democrat 9-1)
Status: (Passed) 2023-06-12 - Effective on 9/1/23 [HB755 Detail]
Download: Texas-2023-HB755-Enrolled.html
| H.B. No. 755 | ||
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| relating to prior authorization for prescription drug benefits | ||
| related to the treatment of autoimmune diseases and certain blood | ||
| disorders. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1369, Insurance Code, is amended by | ||
| adding Subchapter N to read as follows: | ||
| SUBCHAPTER N. COVERAGE OF PRESCRIPTION DRUGS FOR AUTOIMMUNE | ||
| DISEASES AND CERTAIN BLOOD DISORDERS | ||
| Sec. 1369.651. DEFINITION. In this subchapter, | ||
| "prescription drug" has the meaning assigned by Section 551.003, | ||
| Occupations Code. | ||
| Sec. 1369.652. 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) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; and | ||
| (8) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor 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. 1369.653. EXCEPTIONS. (a) This subchapter does not | ||
| apply to: | ||
| (1) a plan that provides coverage: | ||
| (A) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; or | ||
| (B) only for hospital expenses; | ||
| (2) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| or | ||
| (3) the child health plan program under Chapter 62, | ||
| Health and Safety Code. | ||
| (b) 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. 1369.654. PROHIBITION ON MULTIPLE PRIOR | ||
| AUTHORIZATIONS. (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 an autoimmune | ||
| disease, hemophilia, or Von Willebrand disease. | ||
| (b) This section does not apply to: | ||
| (1) opioids, benzodiazepines, barbiturates, or | ||
| carisoprodol; | ||
| (2) prescription drugs that have a typical treatment | ||
| period of less than 12 months; | ||
| (3) drugs that: | ||
| (A) have a boxed warning assigned by the United | ||
| States Food and Drug Administration for use; and | ||
| (B) must have specific provider assessment; or | ||
| (4) the use of a drug approved for use by the United | ||
| States Food and Drug Administration in a manner other than the | ||
| approved use. | ||
| SECTION 2. 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, 2024. | ||
| SECTION 3. This Act takes effect September 1, 2023. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I certify that H.B. No. 755 was passed by the House on May 2, | ||
| 2023, by the following vote: Yeas 129, Nays 15, 3 present, not | ||
| voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| I certify that H.B. No. 755 was passed by the Senate on May | ||
| 22, 2023, by the following vote: Yeas 31, Nays 0. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| APPROVED: _____________________ | ||
| Date | ||
| _____________________ | ||
| Governor | ||
