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 provisions. Specifically, it defines "prescription drug" and outlines the types of health benefit plans to which the new rules apply, including various insurance policies and agreements.

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 determines that federal authorization is needed for any part of the Act, implementation can be delayed until such authorization is obtained. 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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