Ins. Code Section 1369.004
(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.
Section 1369.004 — Coverage Required,
https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1369.htm#1369.004 (accessed Dec. 2, 2023).