one prior authorization a year, now for chronic conditions

The text as introduced · 331 words

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.