By Maxey, Coleman H.B. No. 1377 75R10251 SAW-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to drug benefits available under certain health care 1-3 programs administered by the Texas Department of Health. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter B, Chapter 32, Human Resources Code, 1-6 is amended by adding Section 32.0311 to read as follows: 1-7 Sec. 32.0311. DRUG REIMBURSEMENT UNDER CERTAIN PROGRAMS. 1-8 The department shall require a recipient of medical assistance to 1-9 exhaust drug benefits available under the medical assistance 1-10 program before reimbursing the recipient, pharmacist, or other 1-11 health care provider for drugs purchased by or on behalf of the 1-12 recipient under the Kidney Health Care Program or the Chronically 1-13 Ill and Disabled Children's Services Program. 1-14 SECTION 2. Subchapter B, Chapter 12, Health and Safety Code, 1-15 is amended by adding Section 12.020 to read as follows: 1-16 Sec. 12.020. DRUG REBATES. (a) The department shall 1-17 develop a drug manufacturer rebate program for drugs purchased by 1-18 or on behalf of a client of the Kidney Health Care Program or the 1-19 Chronically Ill and Disabled Children's Services Program. 1-20 (b) The department shall seek rebates in amounts established 1-21 under the Medicaid drug manufacturer rebate program for drugs 1-22 covered by Medicaid that are purchased by or on behalf of clients 1-23 of the Kidney Health Care Program or the Chronically Ill and 1-24 Disabled Children's Services Program who are not eligible for 2-1 Medicaid. 2-2 (c) The department shall consult with drug manufacturers to 2-3 develop rebate amounts for drugs not covered by Medicaid that are 2-4 purchased by or on behalf of clients of the Kidney Health Care 2-5 Program or the Chronically Ill and Disabled Children's Services 2-6 Program. The average percentage savings from rebates for these 2-7 drugs may not be less than the average percentage savings from drug 2-8 rebates under the Medicaid drug manufacturer rebate program. 2-9 (d) Notwithstanding Subsections (b) and (c), the department 2-10 is not required to seek a rebate or develop a rebate amount for a 2-11 drug purchased at a price, including a price set under 42 U.S.C. 2-12 Section 256b, that is lower than the price after rebate of the drug 2-13 under the Medicaid drug manufacturer rebate program. 2-14 (e) Amounts recovered by the department under the drug 2-15 rebate program established under this section may be appropriated 2-16 only for the Kidney Health Care Program or the Chronically Ill and 2-17 Disabled Children's Services Program. 2-18 (f) The department by rule may require all drug 2-19 manufacturers to participate in the rebate program as a condition 2-20 of reimbursement for the manufacturers' drugs under the Kidney 2-21 Health Care Program and the Chronically Ill and Disabled Children's 2-22 Services Program. 2-23 SECTION 3. Chapter 35, Health and Safety Code, is amended by 2-24 adding Section 35.0041 to read as follows: 2-25 Sec. 35.0041. REIMBURSEMENT FOR HEMOPHILIA FACTOR. The 2-26 department shall set the reimbursement rate for hemophilia factor 2-27 claims made under this chapter at the price set for hemophilia 3-1 factor under 42 U.S.C. Section 256b, plus any additional amount the 3-2 department determines reasonable as a dispensing fee. 3-3 SECTION 4. (a) To the extent authorized by federal law, the 3-4 Texas Department of Health shall consolidate with the Medicaid 3-5 Vendor Drug Program the drug benefits components of the Kidney 3-6 Health Care Program and the Chronically Ill and Disabled Children's 3-7 Services Program. 3-8 (b) Except as provided by Subsection (c) of this section or 3-9 other law, the department shall use the Medicaid Vendor Drug 3-10 Program's claims processing and program monitoring procedures, 3-11 pharmacy network, and reimbursement rates for the consolidated 3-12 program. The department shall use the Medicaid Vendor Drug 3-13 Program's prior authorization and dispute resolution procedures and 3-14 approval criteria for the consolidated program to the extent that 3-15 use of those procedures and criteria is consistent with funding and 3-16 policy considerations of the Kidney Health Care Program and the 3-17 Chronically Ill and Disabled Children's Services Program. 3-18 (c) The department shall develop reimbursement rates for 3-19 drugs purchased by or on behalf of a client of the Kidney Health 3-20 Care Program or the Chronically Ill and Disabled Children's 3-21 Services Program that are not included in the Medicaid Vendor Drug 3-22 Program's list of reimbursable drugs. 3-23 (d) The department shall update its computer system to 3-24 facilitate the consolidation. 3-25 SECTION 5. (a) Not later than September 1, 1997, the Texas 3-26 Department of Health shall implement the drug manufacturer rebate 3-27 program required by Section 12.020, Health and Safety Code, as 4-1 added by this Act. 4-2 (b) Not later than March 1, 1999, the Texas Department of 4-3 Health shall complete the implementation of the consolidated 4-4 program required by Section 4 of this Act. 4-5 SECTION 6. The importance of this legislation and the 4-6 crowded condition of the calendars in both houses create an 4-7 emergency and an imperative public necessity that the 4-8 constitutional rule requiring bills to be read on three several 4-9 days in each house be suspended, and this rule is hereby suspended, 4-10 and that this Act take effect and be in force from and after its 4-11 passage, and it is so enacted.