HB2528 - Relating to health benefit plan coverage of prescription drugs for opioid and substance use disorders.

      By: Bucy H.B. No. 2528       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage of prescription drugs for   opioid and substance use disorders.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1369, Insurance Code, is amended by   adding Subchapter E-3 to read as follows:           SUBCHAPTER E-3.   COVERAGE OF MEDICATION-ASSISTED TREATMENT   FOR OPIOID OR SUBSTANCE USE DISORDER           Sec.   1369.231.     DEFINITION. In this subchapter,   "medication-assisted opioid or substance use disorder treatment"   means the use of methadone, buprenorphine, buprenorphine/naloxone,   or naltrexone to treat opioid or substance use disorder.           Sec.   1369.232.     APPLICABILITY OF SUBCHAPTER. (a)     This   subchapter applies only to a health benefit plan that provides   benefits for medical or surgical 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)     nonprofit agricultural organization health   benefits offered by a nonprofit agricultural organization under   Chapter 1682;                 (4)     alternative health benefit coverage offered by a   subsidiary of the Texas Mutual Insurance Company under Subchapter   M, Chapter 2054;                 (5)     health benefits provided by or through a church   benefits board under Subchapter I, Chapter 22, Business   Organizations Code;                 (6)     a regional or local health care program operated   under Section 75.104, Health and Safety Code; or                 (7)     a self-funded health benefit plan sponsored by a   professional employer organization under Chapter 91, Labor 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.   1369.233.     EXCEPTIONS TO APPLICABILITY OF SUBCHAPTER.     This subchapter does not apply to an issuer or provider of health   benefits under or a pharmacy benefit manager administering pharmacy   benefits under:                 (1)     the state Medicaid program, including the Medicaid   managed care program under Chapter 533, Government Code; or                 (2)     the child health plan program under Chapter 62,   Health and Safety Code.           Sec.   1369.234.     LIMITATIONS ON PRIOR AUTHORIZATION. A   health benefit plan that provides coverage for medication-assisted   opioid or substance use disorder treatment may not require an   enrollee to obtain prior authorization for the treatment, except as   needed to minimize the opportunity for fraud, waste, and abuse.          SECTION 2.  This Act applies only to a health benefit plan   delivered, issued for delivery, or renewed on or after January 1,   2026. A health benefit plan delivered, issued for delivery, or   renewed before January 1, 2026, is governed by the law as it existed   immediately before the effective date of this Act, and that law is   continued in effect for that purpose.          SECTION 3.  This Act takes effect September 1, 2025.