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) to the extent possible, require clinically 2-18 appropriate prior authorization for prescription drug benefits in 2-19 the same manner as prior authorization is required under the vendor 2-20 drug program; and 2-21 (4) establish a drug utilization review program to 2-22 ensure the appropriate use of prescription drugs under the state 2-23 program. 2-24 (c) In adopting rules for the state prescription drug 2-25 program, the commission shall consult with an advisory panel 2-26 composed of an equal number of physicians, pharmacists, and 2-27 pharmacologists appointed by the commissioner. 3-1 Sec. 531.303. GENERIC EQUIVALENT AUTHORIZED. In adopting 3-2 rules under the state program, the commission may require that, 3-3 unless the practitioner's signature on a prescription clearly 3-4 indicates that the prescription must be dispensed as written, the 3-5 pharmacist may select a generic equivalent of the prescribed drug. 3-6 Sec. 531.304. PROGRAM FUNDING PRIORITIES. If money available 3-7 for the state prescription drug program is insufficient to provide 3-8 prescription drug benefits to all persons who are eligible under 3-9 Section 531.301(b), the commission shall limit the number of 3-10 enrollees based on available funding and shall provide the 3-11 prescription drug benefits to eligible persons in the following 3-12 order of priority: 3-13 (1) persons eligible under Section 531.301(b)(1); 3-14 (2) persons eligible under Section 531.301(b)(2); and 3-15 (3) persons eligible under Sections 531.301(b)(3), 3-16 (4), and (5). 3-17 SECTION 2. Not later than January 1, 2002, the Health and 3-18 Human Services Commission shall develop and implement the state 3-19 prescription drug program under Subchapter I, Chapter 531, 3-20 Government Code, as added by this Act. 3-21 SECTION 3. This Act takes effect September 1, 2001. _______________________________ _______________________________ President of the Senate Speaker of the House I certify that H.B. No. 1094 was passed by the House on April 26, 2001, by the following vote: Yeas 145, Nays 0, 1 present, not voting; that the House refused to concur in Senate amendments to H.B. No. 1094 on May 18, 2001, and requested the appointment of a conference committee to consider the differences between the two houses; and that the House adopted the conference committee report on H.B. No. 1094 on May 27, 2001, by a non-record vote. _______________________________ Chief Clerk of the House I certify that H.B. No. 1094 was passed by the Senate, with amendments, on May 16, 2001, by a viva-voce vote; at the request of the House, the Senate appointed a conference committee to consider the differences between the two houses; and that the Senate adopted the conference committee report on H.B. No. 1094 on May 27, 2001, by a viva-voce vote. _______________________________ Secretary of the Senate APPROVED: __________________________ Date __________________________ Governor