HB 3542

relating to the effect of a pharmacy benefit manager change on
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Chapter 1369, Insurance Code, is amended by
adding Subchapter A-1 to read as follows:
SUBCHAPTER A-1. CONTINUOUS COVERAGE REQUIREMENTS
Sec. 1369.021.  DEFINITION.  In this subchapter,
"prescription drug" has the meaning assigned by Section 551.003,
Sec. 1369.022.  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)  a basic coverage plan under Chapter 1551;
(4)  a basic plan under Chapter 1575;
(5)  a primary care coverage plan under Chapter 1579;
(6)  a plan providing basic coverage under Chapter
(7)  nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
(8)  alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
(9)  health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
(10)  group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(11)  the state Medicaid program, including the
Medicaid managed care program operated under Chapter 540,
(12)  the child health plan program under Chapter 62,
(13)  a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(14)  a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(15)  county employee group health benefits provided
under Chapter 157, Local Government Code; and
(16)  health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1369.023.  EFFECT OF PHARMACY BENEFIT MANAGER CHANGE ON
PRESCRIPTION DRUG COVERAGE.  A health benefit plan may not deny or
limit an enrollee's coverage of a prescription drug solely because
of a change in the plan's pharmacy benefit manager.
SECTION 2.  If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3.  The changes in law made by this Act apply only to
a health benefit plan delivered, issued for delivery, or renewed on
SECTION 4.  This Act takes effect September 1, 2025.