HB 2528

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
(2)  a group hospital service corporation operating
(3)  a health maintenance organization operating under
(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
(7)  a fraternal benefit society operating under
(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
(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
(3)  nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
(4)  alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
(5)  health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
(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
(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,
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.