The bill, H.B. No. 3542, introduces new regulations regarding the impact of changes in pharmacy benefit managers on prescription drug coverage within health benefit plans in Texas. It adds a new subchapter, Subchapter A-1, to Chapter 1369 of the Insurance Code, which includes definitions and applicability of the new rules. Specifically, it defines "prescription drug" and outlines the types of health benefit plans to which the new regulations apply, including various insurance policies, health maintenance organizations, and Medicaid programs.

A key provision of the bill states that health benefit plans cannot deny or limit an enrollee's coverage of a prescription drug solely due to a change in the plan's pharmacy benefit manager. The bill also stipulates that if a state agency requires a federal waiver for implementation, it may delay the implementation until such a waiver is granted. The changes will take effect for health benefit plans delivered, issued, or renewed on or after January 1, 2026, with the overall act becoming effective on September 1, 2025.

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