Texas Insurance Code - INS § 1369.304. Standard Form

(1) prescribe a single, standard form for requesting prior authorization of prescription drug benefits;

(2) require a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits to use the form for any prior authorization of prescription drug benefits required by the plan;

(3) require that the department and a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers prescription drug benefits make the form available electronically on the website of:

(4) establish penalties for failure to accept the form and acknowledge receipt of the form as required by commissioner rule.

(1) develop the form with input from the advisory committee on uniform prior authorization forms established under Section 1369.305;  and

(2) take into consideration: