yourstate.us
Tex. Insurance Code § 1369.004

COVERAGE REQUIRED

Texas · Texas Insurance Code · Status: effective

Get this as JSONEmbed this
Cite this
Citation
Tex. Insurance Code § 1369.004, COVERAGE REQUIRED, Texas, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/682152
Permanent ID
ys:prov:682152@1
SHA-256
2d4c2c178fdffb3dba04b8d922670afd3e60422f2bc2ab9425385c10f359045d

The hash is SHA-256 of this version's text, with every run of whitespace collapsed to a single space and the ends trimmed. The ID always leads back here, and checking it says whether the text you cited is still the current version.

Full text

(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.