Your health plan could not require advance approval for medication-assisted addiction treatment
What it does
HB 562 would add a new subchapter to the Insurance Code covering medication-assisted treatment for opioid and substance use disorders, which the bill defines as methadone, buprenorphine, buprenorphine/naloxone, or naltrexone. It would apply to insurance policies, hospital service contracts, health maintenance organizations and other health plans issued in Texas, as well as small employer plans, standard plans, and self-funded plans sponsored by a professional employer organization. A plan that covers this treatment could not require you to get prior authorization, except to reduce the chance of fraud, waste and abuse. The new rules would not reach Medicaid or the child health plan program, and the bill text here sets rules for plans that already cover this treatment rather than adding a new coverage requirement.
What it means for your community
If you take medication for opioid or substance use disorder and your plan covers it, the plan could not make you wait for permission before treatment, except to guard against fraud, waste and abuse. That would reach people whose coverage comes through a small employer, a standard plan, or a self-funded plan at work, and it would apply to group plans covering Texas residents even when the policy was issued elsewhere. The change would apply to plans delivered, issued for delivery, or renewed on or after Jan. 1, 2028, and the bill takes effect Sept. 1, 2027.
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