87R18360 SCL-F
 
  By: Oliverson, Bonnen, Collier, Canales, H.B. No. 18
      Burrows, et al.
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to establishment of the prescription drug savings program
  for certain uninsured individuals.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  SHORT TITLE. This Act shall be known as "Texas
  Cares."
         SECTION 2.  PRESCRIPTION DRUG SAVINGS PROGRAM. Subtitle C,
  Title 2, Health and Safety Code, is amended by adding Chapter 65 to
  read as follows:
  CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
  UNINSURED INDIVIDUALS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 65.001.  DEFINITIONS. In this chapter:
               (1)  "Enrollee" means an individual enrolled in the
  program.
               (2)  "Fund" means the trust fund established under
  Section 65.101.
               (3)  "Pharmacy benefit manager" has the meaning
  assigned by Section 4151.151, Insurance Code.
               (4)  "Prescription drug" has the meaning assigned by
  Section 551.003, Occupations Code.
               (5)  "Program" means the prescription drug savings
  program established under this chapter.
               (6)  "Uninsured individual" means an individual
  without health benefit plan coverage for a prescription drug
  benefit.
         Sec. 65.002.  CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
  chapter does not establish an entitlement to assistance in
  obtaining benefits for uninsured individuals.
         (b)  The purpose of this chapter is to establish a program to
  provide uninsured individuals access to prescription drug benefits
  using money from the fund to pay an amount equal to the value of a
  prescription drug rebate at the point of sale and returning that
  rebate amount to the fund to ensure the amounts credited to the fund
  equal the amounts paid from the fund.
         (c)  This chapter does not expand the Medicaid program.
         Sec. 65.003.  RULES. The executive commissioner shall adopt
  rules as necessary to implement this chapter.
  SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
  DRUG SAVINGS PROGRAM
         Sec. 65.051.  ESTABLISHMENT OF PROGRAM. (a) The commission
  shall develop and design a prescription drug savings program that
  partners with a pharmacy benefit manager to offer prescription
  drugs at a discounted rate to uninsured individuals.
         (b)  In developing and implementing the program, the
  commission shall ensure the program benefits do not include
  prescription drugs used for the elective termination of a
  pregnancy.
         (c)  The executive commissioner shall ensure the program is
  designed to provide the greatest possible value to uninsured
  individuals served by the program, while considering the adequacy
  of the prescription drug formulary, net costs of the drugs to
  enrollees, cost to the state, and other important factors
  determined by the commission.
         Sec. 65.052.  GENERAL POWERS AND DUTIES OF COMMISSION
  RELATED TO PROGRAM. (a) The commission shall oversee the
  implementation of the program and coordinate the activities of each
  state agency involved in that implementation.
         (b)  The commission shall design the program to be cost
  neutral by collecting prescription drug rebates after using money
  in the fund in amounts equal to the rebate amounts to purchase
  prescription drugs.
         (c)  The commission shall develop procedures for accepting
  applications for program enrollment, including a process to:
               (1)  determine eligibility, screening, and enrollment
  procedures that allow applicants to self attest to the extent
  authorized by federal law; and
               (2)  resolve disputes related to eligibility
  determinations.
         (d)  The commission shall publish on an Internet website all
  average consumer costs for each prescription drug available through
  the program.
         (e)  The commission and the contracted pharmacy benefit
  manager shall integrate manufacturer and other third-party patient
  assistance programs into the program to the extent feasible. A
  manufacturer or other third party may decline to link the
  manufacturer's or third party's patient assistance program to the
  program. The commission shall give preference to integrating
  patient assistance programs by listing information on those patient
  assistance programs in a central location on the Internet website
  described by Subsection (d) that directs patients to those patient
  assistance programs as appropriate.
         (f)  The commission shall ensure the program has access to an
  adequate pharmacy network and give preference to conducting the
  program using a state pharmaceutical assistance program.
         (g)  The commission is not required to enter into stand-alone
  contracts under this chapter. The commission may add the program,
  wholly or partly, to existing contracts to increase efficiency.
         Sec. 65.053.  PHARMACY BENEFIT MANAGER CONTRACT,
  MONITORING, AND REPORTING REQUIREMENTS. (a) The commission shall
  contract with a pharmacy benefit manager to provide discounted
  prescription drugs to enrollees under the program.
         (b)  The commission shall monitor through reporting or other
  methods the contracted pharmacy benefit manager to ensure
  performance under the contract and quality delivery of services.
         (c)  The contracted pharmacy benefit manager shall report to
  the commission on the commission's request information related to
  the program, including information on rebate amounts, prescription
  drug rates contracted with pharmacies, administrative costs, and
  out-of-pocket costs paid by enrollees at the point of sale of the
  prescription drugs.
         Sec. 65.054.  CONTRACT FUNCTIONS. (a) The commission may
  contract with a third-party administrator or other entity to
  perform any or all program functions for the commission under this
  chapter and may delegate decisions about the policies of the
  program to the third-party administrator or other entity.
         (b)  A third-party administrator or other entity may perform
  tasks under a contract entered into under Subsection (a) that would
  otherwise be performed by the commission.
         Sec. 65.055.  COMMUNITY OUTREACH CAMPAIGN. The commission
  shall conduct or contract to conduct a community outreach and
  education campaign in the form and manner determined by the
  commission to provide information on the program's availability to
  eligible individuals.
  SUBCHAPTER C. TRUST FUND; PROGRAM SUSPENSION
         Sec. 65.101.  ESTABLISHMENT OF FUND. (a) A trust fund is
  established outside the state treasury for the purposes of this
  chapter only if this state receives federal money that may be used
  for the purposes of this chapter and that federal money is directed
  to be deposited to the credit of the fund as provided by law.
         (b)  The fund consists of:
               (1)  gifts, grants, and donations received by this
  state for the purposes of the fund;
               (2)  legislative appropriations of money for the
  purposes of this chapter;
               (3)  federal money available to this state that by law
  may be used for the purposes of this chapter; and
               (4)  interest, dividends, and other income of the fund.
         (c)  The commission shall administer the fund as trustee for
  the benefit of the program established by this chapter.
         (d)  Money in the fund may be used only to administer the
  program and provide program services.
         (e)  The commission shall ensure money spent from the fund to
  assist enrollees in purchasing prescription drugs is cost neutral
  after collecting the prescription drug rebates under the program.
         (f)  The commission may solicit and accept gifts, grants, and
  donations for the fund.
         Sec. 65.102.  FEDERAL MONEY REQUIRED. Notwithstanding any
  other provision of this chapter, the commission may not implement
  the program unless federal money is provided to this state and by
  law made available for deposit to the credit of the fund.
         Sec. 65.1025.  INITIAL COSTS. (a)  The commission may pay
  the program's one-time start-up costs only with federal money in
  the fund.
         (b)  This section expires September 1, 2025.
         Sec. 65.103.  SUSPENSION OF PROGRAM. On the fourth
  anniversary of the date the program is established, the commission
  shall suspend the program and seek legislative approval to continue
  the program if the federal money in the fund available to be used
  for the program's one-time start-up costs is depleted and the
  ongoing costs of administering the program are not fully funded
  through enrollee cost sharing.
  SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
         Sec. 65.151.  ELIGIBILITY CRITERIA. (a) Except as provided
  by Subsection (b), an individual is eligible for benefits under the
  program if the individual is:
               (1)  a resident of this state;
               (2)  a citizen or lawful permanent resident of the
  United States; and
               (3)  uninsured, as determined by the commission.
         (b)  If the commission determines necessary, the commission
  may consider an applicant's financial vulnerability as an
  additional factor for determining program eligibility.
         Sec. 65.152.  COST SHARING. (a)  To the extent necessary,
  the commission shall require enrollees to share the cost of the
  program, including requiring enrollees to pay a copayment at the
  point of sale of a prescription drug.
         (b)  The commission must:
               (1)  allow an enrollee to pay all or part of the
  enrollee's share from any source the enrollee selects; and
               (2)  accept another assistance program if that
  assistance program wholly or partly covers the enrollee share of
  the prescription drug cost.
         (c)  The commission shall require an enrollee to pay a
  copayment to compensate the pharmacy, pharmacy benefit manager, and
  commission for the costs of administering the program in accordance
  with Subsection (d) and under the methodology determined by the
  commission.
         (d)  Enrollees shall pay the costs of ongoing administration
  of the program through an additional charge at the point of sale of
  an eligible prescription drug only if the total number of enrollees
  in the program allows for the additional charge to be an amount not
  to exceed the lesser of:
               (1)  $4; or
               (2)  10 percent of the total amount charged at the point
  of sale for the prescription drug.
  SUBCHAPTER E. OPERATION OF PROGRAM
         Sec. 65.201.  PROGRAM BENEFITS. The commission must approve
  program benefits offered under this chapter.  The commission shall
  ensure the benefits comply with all applicable federal and state
  laws, rules, and regulations.
         Sec. 65.202.  REPORTING. (a) A third-party administrator,
  pharmacy benefit manager, or any other entity the commission
  contracts with under Section 65.054 shall report to the commission
  in the form and manner prescribed by the commission on the benefits
  and services provided under the program.
         (b)  The commission shall establish a procedure to monitor
  the provision of benefits and services under this chapter.
         Sec. 65.203.  FRAUD PREVENTION. The executive commissioner
  by rule shall develop and implement fraud prevention and detection
  for pharmacy benefit managers, contracted third parties, and other
  entities involved in the program.
         Sec. 65.204.  ANNUAL PROGRAM REPORTS. Not later than
  December 1 of each year, the commission shall provide a written
  report to the governor, lieutenant governor, speaker of the house
  of representatives, and standing committees of the legislature with
  primary jurisdiction over the program. The report must include:
               (1)  a line-item list of all program administrative
  costs incurred by the commission;
               (2)  the amount of the pharmacy benefit manager and
  third-party administrator fees;
               (3)  the aggregate amounts of rebates anticipated and
  received for the program; and
               (4)  other program expenditures as the commission
  determines appropriate.
         SECTION 3.  INSULIN STUDY.  (a)  In this section,
  "commission" means the Health and Human Services Commission.
         (b)  The commission shall conduct a study on the development
  and implementation of the prescription drug savings program
  established by Chapter 65, Health and Safety Code, as added by this
  Act, in providing post-rebate insulin to enrollees. The commission
  shall determine the effectiveness of the program in providing
  insulin-related services to uninsured individuals in this state and
  any legislative recommendations for improvements to the program.
         (c)  Not later than February 14, 2023, the commission shall
  provide a written report of the results of the study conducted under
  Subsection (b) of this section to the governor, lieutenant
  governor, speaker of the house of representatives, and members of
  the standing committees of the legislature with primary
  jurisdiction over the commission.  The study must include at least
  six months of information on use by and cost to enrollees for
  prescription insulin.
         SECTION 4.  GENERAL STUDY. (a) In this section,
  "commission" means the Health and Human Services Commission.
         (b)  The commission shall conduct a study on the development
  and implementation of the prescription drug savings program
  established by Chapter 65, Health and Safety Code, as added by this
  Act, in providing to enrollees all of the post-rebate formulary of
  prescription drugs. The commission shall determine the
  effectiveness of the program in providing insulin-related services
  to uninsured individuals in this state and any legislative
  recommendations for improvements to the program.
         (c)  Not later than February 14, 2025, the commission shall
  provide a written report on the results of the study conducted under
  Subsection (b) of this section to the governor, lieutenant
  governor, speaker of the house of representatives, and standing
  committees of the legislature with primary jurisdiction over the
  commission. The study must include at least one year of information
  on use by and cost to enrollees for all of the formulary of
  prescription drugs.
         SECTION 5.  TRANSITION. The Health and Human Services
  Commission is not required to submit the initial report under
  Section 65.204, Health and Safety Code, as added by this Act, until
  December 1, 2022.
         SECTION 6.  RULES.  As soon as practicable after the
  effective date of this Act, the executive commissioner of the
  Health and Human Services Commission and any other state agency
  designated by the executive commissioner shall adopt rules
  necessary to implement Chapter 65, Health and Safety Code, as added
  by this Act.
         SECTION 7.  EFFECTIVE DATE.  This Act takes effect September
  1, 2021.