# 28 Tex. Admin. Code § 21.3022: 28 TAC § 21.3022. Continuation of Benefits, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS

> Texas · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3022

## Section

- **Citation:** 28 Tex. Admin. Code § 21.3022
- **Heading:** 28 TAC § 21.3022. Continuation of Benefits, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS
- **Jurisdiction:** Texas
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Texas Administrative Code / Title 28 INSURANCE / Part 1 TEXAS DEPARTMENT OF INSURANCE / Chapter 21 TRADE PRACTICES / 28 TAC § 21.3022

## Text

(a) An issuer of a health benefit plan that offers
 prescription drug benefits must make a prescription drug that was
 approved or covered for a medical condition or mental illness available
 to each enrollee at the contracted benefit level until the health
 benefit plan renewal date. Modifications to drug coverage are not
 permitted until the plan's renewal date.
(b) A health benefit plan issuer may make modifications
 to drug coverage provided under a health benefit plan if:
(1) the modification occurs at the time of coverage
 renewal;
(2) the modification is effective uniformly among all
 group health benefit plan sponsors covered by identical or substantially
 identical health benefit plans, or all individuals covered by identical
 or substantially identical individual health benefit plans, as applicable;
 and
(3) not later than the 60th day before the date the
 modification is effective, the issuer provides written notice of the
 modification to the commissioner, each affected group health benefit
 plan sponsor, each affected enrollee in an affected group health benefit
 plan, and each affected individual health benefit plan holder for
 modifications that:
(A) remove a drug from a formulary;
(B) add a requirement that an enrollee receive prior
 authorization for a drug;
(C) impose or alter a quantity limit for a drug;
(D) impose a step-therapy restriction for a drug; or
(E) move a drug to a higher cost-sharing tier unless
 a generic drug alternative is available.
(c) For purposes of this section, modifications that
 are more favorable to the consumer may be made without notice at any
 time, including modifications that:
(1) add drugs to formularies;
(2) reduce cost sharing; or
(3) delete a utilization review requirement.

## Nearby sections

- [28 Tex. Admin. Code § 21.3001 28 TAC § 21.3001. Applicability and Severability, DIVISION 1. GENERAL PROVISIONS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3001.md)
- [28 Tex. Admin. Code § 21.3002 28 TAC § 21.3002. Definitions; Pharmacy Identification Cards, DIVISION 2. IDENTIFICATION CARDS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3002.md)
- [28 Tex. Admin. Code § 21.3003 28 TAC § 21.3003. Standard Identification Cards, DIVISION 2. IDENTIFICATION CARDS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3003.md)
- [28 Tex. Admin. Code § 21.3004 28 TAC § 21.3004. Issuance of Standard Identification Cards, DIVISION 2. IDENTIFICATION CARDS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3004.md)
- [28 Tex. Admin. Code § 21.3010 28 TAC § 21.3010. Definitions; Coverage of Off-Label Drugs, DIVISION 3. OFF-LABEL DRUGS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3010.md)
- [28 Tex. Admin. Code § 21.3011 28 TAC § 21.3011. Minimum Standards of Coverage for Off-Label Drug Use, DIVISION 3. OFF-LABEL DRUGS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3011.md)
- [28 Tex. Admin. Code § 21.3020 28 TAC § 21.3020. Definitions; Prescription Drug Formulary, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3020.md)
- [28 Tex. Admin. Code § 21.3022 28 TAC § 21.3022. Continuation of Benefits, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3022.md)
- [28 Tex. Admin. Code § 21.3023 28 TAC § 21.3023. Nonformulary Prescription Drugs; Adverse Determination, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3023.md)
- [28 Tex. Admin. Code § 21.3030 28 TAC § 21.3030. Availability of Formulary Information, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3030.md)
- [28 Tex. Admin. Code § 21.3031 28 TAC § 21.3031. Formulary Information for Individual Health Benefit Plans on Issuer's Website, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3031.md)
- [28 Tex. Admin. Code § 21.3032 28 TAC § 21.3032. Formulary Disclosure Requirements for Individual Health Benefit Plans, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3032.md)
- [28 Tex. Admin. Code § 21.3033 28 TAC § 21.3033. Facilitating Comparison Shopping for Individual Health Benefit Plans, DIVISION 4. PRESCRIPTION DRUG FORMULARY COVERAGE AND DISCLOSURE REQUIREMENTS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3033.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_3022. Check the current official text before relying on it. Not legal advice.