Section 1369.0547 - Step Therapy Protocols For Prescription Drugs To Treat Serious Mental Illnesses(a) In this section, "serious mental illness" has the meaning assigned by Section 1355.001. (b) This section applies only to a drug prescribed to an enrollee who is 18 years of age or older to treat a diagnosis of a serious mental illness. (c) A health benefit plan that provides coverage for prescription drugs to treat a serious mental illness may not require, before the health benefit plan provides coverage of a prescription drug approved by the United States Food and Drug Administration, that the enrollee: (1) fail to successfully respond to more than one different drug for each drug prescribed, excluding the generic or pharmaceutical equivalent of the prescribed drug; or (2) prove a history of failure of more than one different drug for each drug prescribed, excluding the generic or pharmaceutical equivalent of the prescribed drug. (d) Subject to Section 1369.0546, a health benefit plan issuer may implement a step therapy protocol to require a trial of a generic or pharmaceutical equivalent of a prescribed prescription drug as a condition of continued coverage of the prescribed drug only: (1) once in a plan year; and (2) if the generic or pharmaceutical equivalent drug is added to the plan's drug formulary. Tex. Ins. Code § 1369.0547
Added by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 684,Sec. 1, eff. 9/1/2023, app. only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2024.