LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 76th Regular Session
  
                               May 10, 1999
  
  
          TO:  Honorable Judith Zaffirini, Chair, Senate Committee on
               Human Services
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  HB494  by Maxey (Relating to drug benefits available
               under certain health care programs administered by the
               Texas Department of Health.), As Engrossed
  
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*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  HB494, As Engrossed:  positive impact of $296,972 through the         *
*  biennium ending August 31, 2001.                                      *
*                                                                        *
*  The bill would make no appropriation but could provide the legal      *
*  basis for an appropriation of funds to implement the provisions of    *
*  the bill.                                                             *
**************************************************************************
  
General Revenue-Related Funds, Five-Year Impact:
  
          ****************************************************
          *  Fiscal Year  Probable Net Positive/(Negative)   *
          *               Impact to General Revenue Related  *
          *                             Funds                *
          *       2000                              $10,853  *
          *       2001                              286,119  *
          *       2002                              286,119  *
          *       2003                              286,119  *
          *       2004                              286,119  *
          ****************************************************
  
All Funds, Five-Year Impact:
  
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*Fiscal    Probable Savings/(Cost) from    Probable Revenue Gain/(Loss)   *
* Year         General Revenue Fund         from General Revenue Fund     *
*                      0001                            0001               *
*  2000                        $(814,946)                        $825,799 *
*  2001                         (814,946)                       1,101,065 *
*  2002                         (814,946)                       1,101,065 *
*  2003                         (814,946)                       1,101,065 *
*  2004                         (814,946)                       1,101,065 *
***************************************************************************
  
Fiscal Analysis
  
The bill would require the Department of Health to develop a drug
manufacturer rebate program for drugs purchased in the Kidney Health
Care and the Chronically Ill and Disabled Children's programs.  The
department would be required to use the Medicaid Vendor Drug Program's
claims processing and program monitoring procedures, prior authorization
safeguards, dispute resolution procedures and approval criteria,
emergency access procedures, pharmacy network, and reimbursement rates
for the consolidated program.  If reimbursement rates for certain
medications do not exist in the Medicaid program, the department would
be allowed to develop new rates.
  
  
Methodology
  
The department estimates that some additional revenues would be generated
through the development of a rebate system.  The numbers in the table
above reflect the most recent revenue estimates available from the
Department of Health.  Some additional costs would be incurred in the
Kidney Health Care program as that program currently reimburses, on
average, 32 percent less than the Vendor Drug Program for
immunosuppressant drugs.  The cost estimates reflect $814,946 per year
associated with an increase in reimbursement rates.
  
  
Local Government Impact
  
No fiscal implication to units of local government is anticipated.
  
  
Source Agencies:   501   Department of Health
LBB Staff:         JK, TP, TH, KF