HB2557 - Relating to prior authorization for prescription drug benefits related to the treatment of chronic health conditions.

  89R4580 DNC-D     By: Jones of Dallas H.B. No. 2557       A BILL TO BE ENTITLED   AN ACT   relating to prior authorization for prescription drug benefits   related to the treatment of chronic health conditions.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  The heading to Subchapter N, Chapter 1369,   Insurance Code, is amended to read as follows:   SUBCHAPTER N.  COVERAGE OF PRESCRIPTION DRUGS FOR CHRONIC HEALTH   CONDITIONS [ AUTOIMMUNE DISEASES AND CERTAIN BLOOD DISORDERS ]          SECTION 2.  Section 1369.651, Insurance Code, is amended to   read as follows:          Sec. 1369.651.   DEFINITIONS [ DEFINITION ].  In this   subchapter :                 (1)     "Chronic health condition" means an illness,   injury, impairment, or physical or mental condition that is   expected to last at least one year and either:                       (A)     requires ongoing medical attention to   effectively manage or to prevent an adverse health event; or                       (B)     limits one or more of the following   activities of daily living:                             (i)  bathing;                             (ii)  personal hygiene;                             (iii)  eating;                             (iv)  toileting;                             (v)  dressing;                             (vi)  bed mobility; or                             (vii)  walking or locomotion.                 (2)  "Prescription [ , "prescription ] drug" has the   meaning assigned by Section 551.003, Occupations Code.          SECTION 3.  Section 1369.654(a), Insurance Code, is amended   to read as follows:          (a)  A health benefit plan issuer that provides prescription   drug benefits may not require an enrollee to receive more than one   prior authorization annually of the prescription drug benefit for a   prescription drug prescribed to treat a chronic health condition,   including an autoimmune disease, hemophilia, neurodegenerative   disease, or Von Willebrand disease.          SECTION 4.  The change in law made by this Act applies only   to a health benefit plan that is 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 5.  This Act takes effect September 1, 2025.