HB1680 - Relating to prior authorization for prescription drug benefits related to the prevention of human immunodeficiency virus infections.

  89R9203 DNC-D     By: Jones of Dallas H.B. No. 1680       A BILL TO BE ENTITLED   AN ACT   relating to prior authorization for prescription drug benefits   related to the prevention of human immunodeficiency virus   infections.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1369, Insurance Code, is amended by   adding Subchapter P to read as follows:   SUBCHAPTER P. COVERAGE OF PRESCRIPTION DRUGS FOR PREVENTING HUMAN   IMMUNODEFICIENCY VIRUS INFECTION           Sec.   1369.751.     DEFINITION. In this subchapter,   "prescription drug" has the meaning assigned by Section 551.003,   Occupations Code.           Sec.   1369.752.     APPLICABILITY OF SUBCHAPTER. (a) This   subchapter applies only to a health benefit plan that provides   benefits for medical, surgical, or prescription drug expenses   incurred as a result of a health condition, accident, or sickness,   including an individual, group, blanket, or franchise insurance   policy or insurance agreement, a group hospital service contract,   or an individual or group evidence of coverage or similar coverage   document that is issued by:                 (1)  an insurance company;                 (2)     a group hospital service corporation operating   under Chapter 842;                 (3)     a health maintenance organization operating under   Chapter 843;                 (4)     an approved nonprofit health corporation that   holds a certificate of authority under Chapter 844;                 (5)     a multiple employer welfare arrangement that holds   a certificate of authority under Chapter 846;                 (6)     a stipulated premium company operating under   Chapter 884;                 (7)     a fraternal benefit society operating under   Chapter 885;                 (8)  a Lloyd's plan operating under Chapter 941; or                 (9)  an exchange operating under Chapter 942.           (b)     Notwithstanding any other law, this subchapter applies   to:                 (1)     a small employer health benefit plan subject to   Chapter 1501, including coverage provided through a health group   cooperative under Subchapter B of that chapter;                 (2)     a standard health benefit plan issued under   Chapter 1507;                 (3)  a basic coverage plan under Chapter 1551;                 (4)  a basic plan under Chapter 1575;                 (5)  a primary care coverage plan under Chapter 1579;                 (6)     a plan providing basic coverage under Chapter   1601;                 (7)     the state Medicaid program, including the Medicaid   managed care program operated under Chapter 540, Government Code;                 (8)     the child health plan program under Chapter 62,   Health and Safety Code;                 (9)     a self-funded health benefit plan sponsored by a   professional employer organization under Chapter 91, Labor Code;                 (10)     county employee group health benefits provided   under Chapter 157, Local Government Code; and                 (11)     health and accident coverage provided by a risk   pool created under Chapter 172, Local Government Code.           (c)     This subchapter applies to coverage under a group health   benefit plan provided to a resident of this state regardless of   whether the group policy, agreement, or contract is delivered,   issued for delivery, or renewed in this state.           Sec.   1369.753.     EXCEPTION. This subchapter does not apply   to an individual health benefit plan issued on or before March 23,   2010, that has not had any significant changes since that date that   reduce benefits or increase costs to the individual.           Sec.   1369.754.     PROHIBITION ON PRIOR AUTHORIZATION. A   health benefit plan issuer that provides prescription drug benefits   may not require an enrollee to receive a prior authorization of the   prescription drug benefit for a prescription drug prescribed to   prevent human immunodeficiency virus infection.          SECTION 2.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 3.  The changes in law made by this Act apply only to   a health benefit plan delivered, issued for delivery, or renewed on   or after January 1, 2026.          SECTION 4.  This Act takes effect September 1, 2025.