Bill Text: TX HB2528 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to health benefit plan coverage of prescription drugs for opioid and substance use disorders.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2025-02-06 - Filed [HB2528 Detail]
Download: Texas-2025-HB2528-Introduced.html
| By: Bucy | H.B. No. 2528 | |
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| 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 | ||
| issued by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (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 | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (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 | ||
| to: | ||
| (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 | ||
| Chapter 1507; | ||
| (3) nonprofit agricultural organization health | ||
| benefits offered by a nonprofit agricultural organization under | ||
| Chapter 1682; | ||
| (4) alternative health benefit coverage offered by a | ||
| subsidiary of the Texas Mutual Insurance Company under Subchapter | ||
| M, Chapter 2054; | ||
| (5) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (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 | ||
| benefits under: | ||
| (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, | ||
| Health and Safety Code. | ||
| 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. | ||
