By Gray, Flores, Kitchen, Naishtat, et al. H.B. No. 1094 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the creation of a state prescription drug program for 1-3 certain Medicare beneficiaries. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Chapter 531, Government Code, is amended by adding 1-6 Subchapter I to read as follows: 1-7 SUBCHAPTER I. STATE PRESCRIPTION DRUG PROGRAM 1-8 Sec. 531.301. DEVELOPMENT AND IMPLEMENTATION OF STATE 1-9 PROGRAM; FUNDING. (a) The commission shall develop and implement a 1-10 state prescription drug program that operates in the same manner as 1-11 the vendor drug program operates in providing prescription drug 1-12 benefits to recipients of medical assistance under Chapter 32, 1-13 Human Resources Code. 1-14 (b) A person is eligible for prescription drug benefits 1-15 under the state program if the person is: 1-16 (1) a qualified Medicare beneficiary, as defined by 42 1-17 U.S.C. Section 1396d(p)(1), as amended; 1-18 (2) a specified low-income Medicare beneficiary who is 1-19 eligible for medical assistance for Medicare cost-sharing payments 1-20 under 42 U.S.C. Section 1396a(a)(10)(E)(iii), as amended; 1-21 (3) a qualified disabled and working individual, as 1-22 defined by 42 U.S.C. Section 1396d(s), as amended; 1-23 (4) a qualifying individual who is eligible for that 1-24 assistance under 42 U.S.C. Section 1396a(a)(10)(E)(iv)(I), as 2-1 amended; or 2-2 (5) a qualifying individual who is eligible for that 2-3 assistance under 42 U.S.C. Section 1396a(a)(10)(E)(iv)(II), as 2-4 amended. 2-5 (c) Prescription drugs under the state program may be funded 2-6 only with state money, unless funds are available under federal law 2-7 to fund all or part of the program. 2-8 Sec. 531.302. RULES. (a) The commission shall adopt all 2-9 rules necessary for implementation of the state prescription drug 2-10 program. 2-11 (b) In adopting rules for the state prescription drug 2-12 program, the commission may: 2-13 (1) require a person who is eligible for prescription 2-14 drug benefits to pay a cost-sharing payment; 2-15 (2) authorize the use of a prescription drug formulary 2-16 to specify which prescription drugs the state program will cover; 2-17 (3) require prior authorization for prescription drug 2-18 benefits under the state program; and 2-19 (4) establish a drug utilization review program to 2-20 ensure the appropriate use of prescription drugs under the state 2-21 program. 2-22 Sec. 531.303. GENERIC EQUIVALENT AUTHORIZED. In adopting 2-23 rules under the state program, the commission may require that, 2-24 unless the practitioner's signature on a prescription clearly 2-25 indicates that the prescription must be dispensed as written, the 2-26 pharmacist may select a generic equivalent of the prescribed drug. 2-27 Sec. 531.304. PROGRAM FUNDING PRIORITIES. If money available 3-1 for the state prescription drug program is insufficient to provide 3-2 prescription drug benefits to all persons who are eligible under 3-3 Section 531.301(b), the commission shall limit the number of 3-4 enrollees based on available funding and shall provide the 3-5 prescription drug benefits to eligible persons in the following 3-6 order of priority: 3-7 (1) persons eligible under Section 531.301(b)(1); 3-8 (2) persons eligible under Section 531.301(b)(2); and 3-9 (3) persons eligible under Sections 531.301(b)(3), 3-10 (4), and (5). 3-11 SECTION 2. Not later than January 1, 2002, the Health and 3-12 Human Services Commission shall develop and implement the state 3-13 prescription drug program under Subchapter I, Chapter 531, 3-14 Government Code, as added by this Act. 3-15 SECTION 3. This Act takes effect September 1, 2001.