SB 1274

relating to prior authorization for prescription drug benefits
related to the prevention of human immunodeficiency virus
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Chapter 1369, Insurance Code, is amended by
adding Subchapter P to read as follows:
SUBCHAPTER P.  COVERAGE OF PRESCRIPTION DRUGS FOR PREVENTING HUMAN
IMMUNODEFICIENCY VIRUS INFECTION
Sec. 1369.751.  DEFINITION.  In this subchapter,
"prescription drug" has the meaning assigned by Section 551.003,
Sec. 1369.752.  APPLICABILITY OF SUBCHAPTER.  (a)  This
subchapter applies only to a health benefit plan that provides
benefits for medical, surgical, or prescription drug 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
(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)  the state Medicaid program, including the Medicaid
managed care program operated under Chapter 540, Government Code;
(8)  the child health plan program under Chapter 62,
(9)  a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(10)  county employee group health benefits provided
under Chapter 157, Local Government Code; and
(11)  health and accident coverage provided by a risk
pool created under Chapter 172, Local Government 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. 1369.753.  EXCEPTION.  This subchapter does not apply
to an individual health benefit plan issued on or before March 23,
2010, that has not had any significant changes since that date that
reduce benefits or increase costs to the individual.
Sec. 1369.754.  PROHIBITION ON PRIOR AUTHORIZATION.  A
health benefit plan issuer that provides prescription drug benefits
may not require an enrollee to receive a prior authorization of the
prescription drug benefit for a prescription drug prescribed to
prevent human immunodeficiency virus infection.
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.