Insurance Code § 1369.094, added by Senate Bill 622, 88th Legislature, 2023, requires health benefit plan issuers that cover prescription drugs to provide information regarding a covered prescription drug to an enrollee or the enrollee's prescribing provider on request. If a request is made through a standard application programming interface (API), the issuer must respond in real time. The requirements in Insurance Code § 1369.094 apply to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2025. These new requirements are in addition to other requirements, including those in Insurance Code § 1661.002 and § 1662.051.
Insurance Code § 1369.094(e) permits an issuer with fewer than 10,000 enrollees to receive additional time to comply with Insurance Code § 1369.094.
- An issuer may register for a 12-month extension by submitting information to LHLMgmt@tdi.texas.gov stating the total number of enrollees covered in health benefit plans offered by the issuer. Under Insurance Code § 1369.094, a health benefit plan issuer must have fewer than 10,000 enrollees to receive a 12-month extension, and an issuer that receives an extension must comply with the requirements of the section for a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2026, unless it receives a temporary exception from one or more of the requirements.
- After the 12-month extension, an issuer may request a temporary exception from one or more requirements of Insurance Code § 1369.094 by submitting a request to LHLMgmt@tdi.texas.gov that demonstrates that compliance would impose an unreasonable cost relative to the public value that would be gained from full compliance.
The statute does not authorize the Texas Department of Insurance to grant extensions or exceptions to issuers that do not qualify under Insurance Code § 1369.094(e).