The bill amends the Texas Insurance Code to modify certain prescription drug benefits and coverage provided by health benefit plans. It introduces new provisions that prohibit health benefit plan issuers from modifying an enrollee's contracted benefit level for any prescription drug that was approved or covered in the previous plan year, provided specific conditions are met. Additionally, the bill outlines the requirements for health benefit plan issuers to notify enrollees and relevant parties about any modifications to drug coverage, including the type of modification and its implications. Notably, the bill allows for modifications that are more favorable to enrollees to be made at any time without requiring prior notice.

Furthermore, the bill expands the list of exceptions to the applicability of certain provisions in the Insurance Code, including the addition of self-funded health benefit plans and Medicaid managed care programs. It also clarifies that modifications affecting drug coverage that require notice include actions such as removing a drug from a formulary or increasing out-of-pocket expenses. The changes will apply to health benefit plans delivered, issued for delivery, 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)