H.B. No. 4673 amends the Texas Insurance Code to address the impact of reductions in out-of-pocket expenses for prescription drugs classified as essential health benefits on enrollees' cost-sharing requirements. The bill specifies that these reductions apply to situations where a generic equivalent or interchangeable biological product does not exist, or when access to the drug is obtained through prior authorization, step therapy, or exceptions and appeals processes. Additionally, it introduces a new provision that mandates health benefit plan issuers, pharmacy benefit managers, or subcontractors to apply any reductions in out-of-pocket expenses for essential health benefit drugs to the enrollee's deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum, regardless of how the drug is classified.

The bill will take effect on September 1, 2025, and will apply only to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026. Plans that are delivered or renewed before this date will continue to be governed by the existing law prior to the amendments made by this Act.

Statutes affected:
Introduced: Insurance Code 1369.0542 (Insurance Code 1369)