Bill > SB959

This bill modifies regulations for health benefit plan issuers regarding prescription drug coverage, primarily focusing on protecting patients' access to medications. The bill expands the types of health benefit plans subject to these regulations by adding self-funded health benefit plans, and introduces new requirements for how insurers can modify drug coverage. Specifically, when a health plan renews, the issuer cannot change the benefit level for prescription drugs that were previously approved and prescribed for a specific medical condition, as long as the enrollee was continuously covered and a physician determines the drug is the most appropriate treatment. The bill prohibits insurers from removing drugs from formularies, increasing out-of-pocket costs, or imposing new authorization requirements for such medications. There are exceptions for drugs with safety concerns or manufacturing issues, and the bill allows pharmacists to substitute interchangeable generic products. The changes will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, providing a transition period for insurers to adapt to the new requirements. The bill aims to provide more stability and predictability for patients managing ongoing medical conditions by restricting sudden changes to their prescription drug coverage.

Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB959