TX HB4673

Requires health benefit plan issuers, pharmacy benefit managers, and subcontractors to apply any out-of-pocket expense reductions (such as manufacturer coupons or assistance programs) for prescription drugs classified as essential health benefits toward the enrollee's deductible, copayment, cost-sharing, or out-of-pocket maximum

Applies regardless of whether the plan issuer, pharmacy benefit manager, or subcontractor classifies the specific drug as an essential health benefit, as long as it falls within federal essential health benefit categories under 42 U.S.C. Section 18022(b)(1)

Maintains existing provisions that allow certain cost-sharing assistance to count toward out-of-pocket limits for brand-name drugs without generic equivalents or interchangeable biological products, or when enrollees obtained access through prior authorization, step therapy, or appeals processes

Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2026

Takes effect September 1, 2025