The bill, S.B. No. 959, proposes modifications to prescription drug benefits and coverage under certain health benefit plans in Texas. It amends Section 1369.053 of the Insurance Code to clarify that the subchapter does not apply to various types of health benefit plans, including Medicaid managed care programs and self-funded health benefit plans as defined by the Employee Retirement Income Security Act of 1974. Additionally, it introduces new requirements for health benefit plan issuers regarding modifications to drug coverage, mandating that any changes must be uniformly applied and communicated to affected parties at least 60 days prior to their implementation.

Furthermore, the bill establishes that upon renewal of a health benefit plan, issuers cannot modify an enrollee's contracted benefit level for any prescription drug that was previously covered, provided certain conditions are met. It outlines specific modifications that are prohibited, such as removing drugs from formularies or increasing out-of-pocket expenses, while allowing for more favorable changes to be made without notice. The changes will apply to health benefit plans delivered or renewed on or after January 1, 2026, with the act taking effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1369.0541, Insurance Code 1369.055 (Insurance Code 1369)