Bill Text: TX SB634 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to prior authorization for prescription drug benefits related to the treatment of chronic and autoimmune diseases.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2023-02-17 - Referred to Health & Human Services [SB634 Detail]
Download: Texas-2023-SB634-Introduced.html
| 88R1759 CJD-D | ||
| By: Menéndez | S.B. No. 634 | |
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| relating to prior authorization for prescription drug benefits | ||
| related to the treatment of chronic and autoimmune diseases. | ||
| 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 CHRONIC AND | ||
| AUTOIMMUNE DISEASES | ||
| 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) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (9) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| (10) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (11) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (12) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (13) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (14) 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. 1369.653. EXCEPTIONS. (a) This subchapter does not | ||
| apply to a plan that provides coverage: | ||
| (1) 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 | ||
| (2) only for hospital expenses. | ||
| (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 PRIOR AUTHORIZATION. A | ||
| health benefit plan issuer that provides prescription drug benefits | ||
| may not require prior authorization of the prescription drug | ||
| benefit for a prescription drug prescribed to treat a chronic or | ||
| autoimmune disease. | ||
| 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. 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 4. This Act takes effect September 1, 2023. | ||
