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.