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COMMITTEE VOTE |
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YeaNayAbsentPNV |
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KolkhorstX |
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BlancoX |
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HallX |
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HancockX |
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A BILL TO BE ENTITLED
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AN ACT
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relating to prescription drug benefits under Medicaid and the child |
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health plan program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0691 to read as follows: |
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Sec. 531.0691. VENDOR DRUG PROGRAM INCLUSION. The |
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commission shall ensure that the vendor drug program includes all |
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drugs and national drug codes made available on the federal |
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Medicaid Drug Rebate Program regardless of the status of the |
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certification of information for the drug. |
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SECTION 2. Chapter 533, Government Code, is amended by |
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adding Subchapter C to read as follows: |
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SUBCHAPTER C. PRESCRIPTION DRUG BENEFITS UNDER CERTAIN OUTPATIENT |
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PHARMACY BENEFIT PLANS |
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Sec. 533.071. PREFERRED DRUG LIST EXCEPTIONS. (a) The |
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commission shall adopt rules allowing exceptions to the preferred |
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drug list if: |
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(1) the drug required under the preferred drug list: |
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(A) is contraindicated; |
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(B) will likely cause an adverse reaction in or |
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physical or mental harm to the recipient; or |
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(C) is expected to be ineffective based on the |
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known clinical characteristics of the recipient and the known |
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characteristics of the prescription drug regimen; |
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(2) the recipient previously discontinued taking the |
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preferred drug at any point in the recipient's clinical history and |
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for any length of time because the drug: |
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(A) was not effective; |
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(B) had a diminished effect; or |
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(C) resulted in an adverse event; |
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(3) the recipient was prescribed and is taking a |
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nonpreferred drug in the antidepressant or antipsychotic drug class |
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and the recipient: |
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(A) was prescribed the nonpreferred drug before |
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being discharged from an inpatient facility; |
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(B) is stable on the nonpreferred drug; and |
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(C) is at risk of experiencing complications from |
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switching from the nonpreferred drug to another drug; or |
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(4) the preferred drug is not available for reasons |
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outside of the Medicaid managed care organization's control, |
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including because: |
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(A) the drug is in short supply according to the |
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Food and Drug Administration Drug Shortages Database; or |
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(B) the drug's manufacturer has placed the drug |
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on backorder or allocation. |
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(b) An exception provided under this section does not |
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subject the Medicaid managed care plan to liquidated damages for |
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failing to comply with the preferred drug list. |
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SECTION 3. Section 531.072, Government Code, is amended by |
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adding Subsections (b-3), (g), and (h) to read as follows: |
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(b-3) Notwithstanding Subsection (b), the preferred drug |
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lists must contain all therapeutic equivalents for a generic drug |
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on the preferred drug list. |
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(g) The commission shall develop an expedited review |
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process to consider requests from managed care organizations and |
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providers to add drugs to the preferred drug list. |
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(h) The commission shall grant temporary non-preferred |
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status to new drugs that are available but have not yet been |
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reviewed by the drug utilization review board and establish |
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criteria for authorizing drugs with temporary non-preferred |
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status. |
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SECTION 4. Section 531.073(b), Government Code, is amended |
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to read as follows: |
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(b) The commission shall establish procedures for the prior |
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authorization requirement under the Medicaid vendor drug program to |
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ensure that the requirements of 42 U.S.C. Section 1396r-8(d)(5) and |
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its subsequent amendments are met. Specifically, the procedures |
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must ensure that: |
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(1) [a prior authorization requirement is not imposed |
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for a drug before the drug has been considered at a meeting of the |
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Drug Utilization Review Board under Section 531.0736; |
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[(2)] there will be a response to a request for prior |
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authorization by telephone or other telecommunications device |
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within 24 hours after receipt of a request for prior authorization; |
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and |
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(2) [(3)] a 72-hour supply of the drug prescribed will |
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be provided in an emergency or if the commission does not provide a |
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response within the time required by Subdivision (1) [(2)]. |
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SECTION 5. Sections 531.0736(c) and (d), Government Code, |
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are amended to read as follows: |
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(c) The executive commissioner shall determine the |
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composition of the board, which must: |
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(1) comply with applicable federal law, including 42 |
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C.F.R. Section 456.716; |
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(2) include three [two] representatives of managed |
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care organizations [as nonvoting members], all [one] of whom must |
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be physicians or pharmacists [a physician and one of whom must be a |
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pharmacist]; |
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(3) include at least 17 physicians and pharmacists |
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who: |
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(A) provide services across the entire |
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population of Medicaid recipients and represent different |
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specialties, including at least one of each of the following types |
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of physicians: |
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(i) a pediatrician; |
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(ii) a primary care physician; |
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(iii) an obstetrician and gynecologist; |
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(iv) a child and adolescent psychiatrist; |
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and |
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(v) an adult psychiatrist; and |
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(B) have experience in either developing or |
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practicing under a preferred drug list; and |
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(4) include a consumer advocate who represents |
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Medicaid recipients. |
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(d) Notwithstanding any other law, members [Members] |
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appointed under Subsection (c)(2) may attend quarterly and other |
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regularly scheduled meetings, but may not: |
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(1) attend portions of the executive sessions in which |
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confidential drug pricing information is shared; or |
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(2) access confidential drug pricing information. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect September 1, 2023. |
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* * * * * |