GroundRules
Tex. Insurance Code § 1369.055: CONTINUATION OF COVERAGE REQUIRED; OTHER DRUGS NOT PRECLUDED.
Where this section sits in the code
- INSURANCE CODE
- TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
- SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES
- CHAPTER 1369. BENEFITS RELATED TO PRESCRIPTION DRUGS AND DEVICES AND RELATED SERVICES
- SUBCHAPTER B. REQUIREMENTS AFFECTING COVERAGE OF SPECIFIC PRESCRIPTION DRUGS OR COST SHARING
(a) An issuer of a health benefit plan that covers prescription drugs shall offer to each enrollee at the contracted benefit level and until the enrollee's plan renewal date any prescription drug that was approved or covered under the plan for a medical condition or mental illness, regardless of whether the drug has been removed from the health benefit plan's drug formulary before the plan renewal date.
(b) This section does not prohibit a physician or other health professional who is authorized to prescribe a drug from prescribing a drug that is an alternative to a drug for which continuation of coverage is required under Subsection (a) if the alternative drug is:
(1) covered under the health benefit plan; and
(2) medically appropriate for the enrollee.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 501 (H.B. 1405), Sec. 6, eff. September 1, 2011.
Collected 2026-08-27T01:47:21Z. Source file · JSON