Tex. Ins. Code § 1369.004 · Subchapter A. COVERAGE OF PRESCRIPTION DRUGS IN GENERAL
COVERAGE REQUIRED.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) A health benefit plan that covers drugs must cover any drug prescribed to treat an enrollee for a chronic, disabling, or life-threatening illness covered under the plan if the drug:
(1) has been approved by the United States Food and Drug Administration for at least one indication; and
(2) is recognized by the following for treatment of the indication for which the drug is prescribed:
(A) a prescription drug reference compendium approved by the commissioner for purposes of this section; or
(B) substantially accepted peer-reviewed medical literature.
(b) Coverage of a drug required under Subsection (a) must include coverage of medically necessary services associated with the administration of the drug.
(c) A health benefit plan issuer may not, based on a "medical necessity" requirement, deny coverage of a drug required under Subsection (a) unless the reason for the denial is unrelated to the legal status of the drug use.
(d) This section does not require a health benefit plan to cover:
(1) experimental drugs that are not otherwise approved for an indication by the United States Food and Drug Administration;
(2) any disease or condition that is excluded from coverage under the plan; or
(3) a drug that the United States Food and Drug Administration has determined to be contraindicated for treatment of the current indication.
Notes and commentary — not statutory text
History
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1369.htm
- Text hash
- sha256 25de09f8e365fd9f92632bd0233363089bcf7d35305316fc0b215dbc38bc54c0
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.