75R10251 SAW-D
By Maxey, Coleman H.B. No. 1377
Substitute the following for H.B. No. 1377:
By Maxey C.S.H.B. No. 1377
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.