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 requires that any modifications affecting drug coverage, such as removing a drug from a formulary or increasing out-of-pocket expenses, must be communicated to enrollees and plan sponsors at least 60 days prior to the effective date of the change. The bill also allows for more favorable modifications to drug coverage to be made at any time without prior notice.

Furthermore, the bill expands the list of exceptions to the applicability of the subchapter, including Medicaid managed care programs and self-funded health benefit plans. It clarifies that modifications that are more favorable to enrollees, such as adding drugs to a formulary or reducing costs, do not require notice. The changes will apply to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2026, while plans renewed before this date will continue to be governed by the previous law. The act is set to take effect on September 1, 2025.

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