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TX HB4674
TX HB4674Relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans.
summary
Introduced
03/12/2025
03/12/2025
In Committee
04/03/2025
04/03/2025
Crossed Over
Passed
Dead
06/02/2025
06/02/2025
Introduced Session
89th Legislature Regular Session
Bill Summary
AN ACT relating to modification of certain prescription drug benefits and coverage offered by certain health benefit plans.
AI Summary
This bill modifies Texas insurance regulations regarding prescription drug benefits and coverage, focusing on protecting patients from unexpected changes in their health benefit plans. The bill expands the types of health benefit plans subject to state regulation by adding self-funded health benefit plans to the list of exceptions. It introduces new requirements for health benefit plan issuers when modifying drug coverage, mandating that they provide detailed written notice at least 60 days before making changes. Critically, the bill prevents plan issuers from modifying an enrollee's prescription drug benefits during plan renewal if the drug was previously approved and prescribed for a specific medical condition, as long as a physician determines it is the most appropriate treatment. The changes prohibit actions like removing drugs from formularies, increasing out-of-pocket expenses, or reducing coverage for specific medications that an enrollee was previously using. The bill does include some exceptions, such as allowing changes if a drug's safety is questioned by the FDA or if a manufacturer discontinues production. These new regulations will apply to health benefit plans delivered, issued, or renewed on or after January 1, 2026, providing patients with greater stability and transparency in their prescription drug coverage.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Referred to Insurance (on 04/03/2025)
bill text
bill summary
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bill summary
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bill summary
Document Type | Source Location |
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State Bill Page | https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4674 |
BillText | https://capitol.texas.gov/tlodocs/89R/billtext/html/HB04674I.htm |
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