The Texas Department of State Health Services (DSHS) is moving forward with new rules that would expand the state’s Compassionate Use Program (TCUP), following direction from House Bill 46 passed earlier this year.
The proposed rules would, for the first time, allow physicians to formally request the addition of medical conditions to the list of qualifying diagnoses eligible for low-THC cannabis prescriptions. Until now, that authority rested solely with lawmakers. The changes would also authorize physicians to prescribe pulmonary inhalation devices for patients, giving those in the program an alternative to oral consumption methods
House Bill 46 significantly broaden the list of qualifying conditions, effective September 1. Chronic pain, Crohn’s disease, and traumatic brain injury (TBI) are some of the new conditions added. Pediatric disorders such as mitochondrial diseases, creatine deficiencies, and lysosomal storage conditions are also recognized. Under the proposed DSHS rules, physicians treating patients with unlisted illnesses would be able to petition DSHS to have those conditions considered for inclusion.
The proposed rules also set a framework for medical devices, defining pulmonary inhalation devices as machines that deliver aerosolized or vaporized cannabis without burning or igniting the substance. Devices would be reviewed twice annually with input from stakeholders, ensuring that new technology could be added to the approved list as it becomes available
The proposed changes are set to take effect October 1, 2025, pending a public comment period that runs through September.
According to a Health and Human Services memo, the “Rule Development Schedule” goes as follows:
- August 21, 2025 Present to HHSC Executive Council
- August 22, 2025 Publish proposed rules in Texas Register
- September 2025 Publish adopted rules in Texas Register
- October 1, 2025 Effective date
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