TX HB4674

Prohibits health benefit plan issuers from modifying an enrollee's contracted benefit level for prescription drugs that were approved or covered in the previous plan year, if the enrollee was continuously covered, the drug was prescribed for a medical condition or mental illness, and the prescriber determines it remains the most appropriate treatment

Expands the list of drug coverage modifications requiring 60-day advance written notice to include increasing out-of-pocket costs (coinsurance, copayments, deductibles) and reducing maximum drug coverage amounts

Requires modification notices to explicitly inform enrollees that issuers cannot change benefit levels for previously covered prescriptions upon plan renewal under the new protections

Exempts self-funded health benefit plans under ERISA from these prescription drug modification requirements, in addition to existing exemptions for Medicare supplements, workers' compensation, Medicaid, and limited-benefit plans

Allows issuers to make favorable modifications (adding drugs to formulary, reducing costs, removing utilization review requirements) at any time without notice, and permits drug removal if the FDA raises safety concerns or the drug is discontinued or withdrawn from the market

Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2026, with an effective date of September 1, 2025