By Maxey H.C.R. No. 288
75R16149 SMC-D
HOUSE CONCURRENT RESOLUTION
1-1 WHEREAS, three major public health programs administered by
1-2 the Texas Department of Health offer clients reimbursement for
1-3 medications: the Medicaid Vendor Drug Program, the Kidney Health
1-4 Care Program, and the Chronically Ill and Disabled Children's
1-5 Services Program; and
1-6 WHEREAS, Of the three, the Vendor Drug Program is the largest
1-7 and most comprehensive of these public health initiatives and is a
1-8 part of Medicaid, the state-federal medical insurance program for
1-9 the poor; and
1-10 WHEREAS, The Chronically Ill and Disabled Children's Services
1-11 Program provides medical care and services to children with special
1-12 needs, and the Kidney Health Care Program provides medical benefits
1-13 for persons suffering from severe kidney disease; and
1-14 WHEREAS, The comptroller's performance review found that the
1-15 Vendor Drug Program is considerably more streamlined and efficient
1-16 than the other two programs and that Texas could accrue significant
1-17 advantages by consolidating drug purchases for all three programs
1-18 under the Vendor Drug Program; and
1-19 WHEREAS, The Vendor Drug Program has saved substantial
1-20 amounts of state revenue by negotiating a rebate from drug
1-21 manufacturers, and savings also could be obtained by negotiating a
1-22 similar rebate under the Chronically Ill and Disabled Children's
1-23 Services Program and the Kidney Health Care Program; and
1-24 WHEREAS, It is appropriate for the department to take steps
2-1 to ensure that all of the programs operate in a manner that best
2-2 serves the clients and the State of Texas; now, therefore, be it
2-3 RESOLVED, That the 75th Legislature of the State of Texas
2-4 hereby direct the Texas Department of Health to require a recipient
2-5 of medical assistance to exhaust drug benefits available under the
2-6 medical assistance program before reimbursing the recipient,
2-7 pharmacist, or other health care provider for drugs purchased by or
2-8 on behalf of the recipient under the Kidney Health Care Program or
2-9 the Chronically Ill and Disabled Children's Services Program; and,
2-10 be it further
2-11 RESOLVED, That the department develop a drug manufacturer
2-12 rebate program for drugs purchased by or on behalf of a client of
2-13 the Kidney Health Care Program or the Chronically Ill and Disabled
2-14 Children's Services Program; and, be it further
2-15 RESOLVED, That the department seek rebates in amounts
2-16 established under the Medicaid drug manufacturer rebate program for
2-17 drugs covered by Medicaid that are purchased by or on behalf of
2-18 clients of the Kidney Health Care Program or the Chronically Ill
2-19 and Disabled Children's Services Program who are not eligible for
2-20 Medicaid; and, be it further
2-21 RESOLVED, That the department consult with drug manufacturers
2-22 to develop rebate amounts for drugs not covered by Medicaid that
2-23 are purchased by or on behalf of clients of the Kidney Health Care
2-24 Program or the Chronically Ill and Disabled Children's Services
2-25 Program; the average percentage savings from rebates for these
2-26 drugs may not be less than the average percentage savings from drug
2-27 rebates under the Medicaid drug manufacturer rebate program; and,
3-1 be it further
3-2 RESOLVED, That, notwithstanding the directive that the
3-3 department seek rebates for certain drugs purchased by Medicaid or
3-4 consult with drug manufacturers to develop rebate amounts for drugs
3-5 not covered by Medicaid, as mentioned above, the department should
3-6 not seek a rebate or develop a rebate amount for a drug purchased
3-7 at a price, including a price set under 42 U.S.C. Section 256b,
3-8 that is lower than the price after rebate of the drug under the
3-9 Medicaid drug manufacturer rebate program; and, be it further
3-10 RESOLVED, That amounts recovered by the department under the
3-11 drug rebate program mentioned above be allocated only for the
3-12 Kidney Health Care Program or the Chronically Ill and Disabled
3-13 Children's Services Program; and, be it further
3-14 RESOLVED, That the department consider adopting rules to
3-15 require all drug manufacturers to participate in the rebate program
3-16 as a condition of reimbursement for the manufacturers' drugs under
3-17 the Kidney Health Care Program or the Chronically Ill and Disabled
3-18 Children's Services Program; and, be it further
3-19 RESOLVED, That the department set the reimbursement rate for
3-20 hemophilia factor claims made under Chapter 35, Health and Safety
3-21 Code, at the price set for hemophilia factor under 42 U.S.C.
3-22 Section 256b, plus any additional amount the department determines
3-23 reasonable as a dispensing fee; and, be it further
3-24 RESOLVED, That, to the extent authorized by federal law, the
3-25 department consolidate with the Medicaid Vendor Drug Program the
3-26 drug benefits components of the Kidney Health Care Program and the
3-27 Chronically Ill and Disabled Children's Services Program; and, be
4-1 it further
4-2 RESOLVED, That, except as provided in applicable law or in
4-3 the requirement mentioned below, the department develop
4-4 reimbursement rates for certain drugs that are not included in the
4-5 Medicaid Vendor Drug Program's list of reimbursable drugs and the
4-6 department use the Medicaid Vendor Drug Program's claims processing
4-7 and program monitoring procedures, pharmacy network, and
4-8 reimbursement rates for the consolidated program and use the
4-9 Medicaid Vendor Drug Program's prior authorization and dispute
4-10 resolution procedures and approval criteria for the consolidated
4-11 program to the extent that use of those procedures and criteria is
4-12 consistent with funding and policy considerations of the Kidney
4-13 Health Care Program and the Chronically Ill and Disabled Children's
4-14 Services Program; and, be it further
4-15 RESOLVED, That the department develop reimbursement rates for
4-16 drugs purchased by or on behalf of a client of the Kidney Health
4-17 Care Program or the Chronically Ill and Disabled Children's
4-18 Services Program that are not included in the Medicaid Vendor Drug
4-19 Program's list of reimbursable drugs and update its computer system
4-20 to facilitate the consolidation; and, be it further
4-21 RESOLVED, That the department implement the drug manufacturer
4-22 rebate program, as mentioned above, not later than September 1,
4-23 1997, and complete the implementation of the consolidated program,
4-24 as mentioned above, not later than March 1, 1999; and, be it
4-25 further
4-26 RESOLVED, That the secretary of state forward an official
4-27 copy of this resolution to the commissioner of health of the Texas
5-1 Department of Health.