SRC-AMY S.C.R. 48 78(R)   BILL ANALYSIS


Senate Research Center   S.C.R. 48
By: Van de Putte et al.
Business & Commerce
5/10/2003
As Filed


DIGEST 

The integrity of the Texas workers' compensation system, which gives
injured workers ready access to medically necessary health care services,
including medically necessary prescription drugs, must be protected.
Currently, statutory, regulatory, and administrative guidelines for
determining payment amounts for prescription drugs under the Labor Code
are vague and do not provide fair notice to providers and workers'
compensation insurance carriers regarding the amounts to be billed and
paid.  The methodology for determining payment amounts for prescription
drugs under state law should be clearly defined.  In order to ensure the
presence of a reliable network of pharmacy providers and workers'
compensation insurance carriers for injured workers in Texas, the
procedures for presenting and processing claims for prescription drugs
under the Labor Code should be made more efficient and less burdensome on
insurance carriers and pharmacy providers. Workers' compensation insurance
carriers and pharmacy providers throughout Texas are working
collaboratively toward the goals set forth in this resolution. 

PURPOSE 

As proposed, S.C.R. 48 submits the following resolutions:

That the 78th Legislature direct the Texas Workers' Compensation
Commission (TWCC) to complete, not later than December 1, 2003, a study of
the additional administrative costs and expenses incurred by pharmacy
providers to process claims and payments for prescription drugs provided
to individuals under the Texas workers' compensation system, relative to
the costs and expenses incurred in providing such drugs to self-paying
individuals or individuals for whom payment is made under insurance
coverage other than workers' compensation insurance. That the 78th
Legislature direct TWCC to promulgate, not later than December 1, 2003,
regulations that clearly define the methodology for determining payment
amounts for prescription drugs under the Texas Workers' Compensation Act,
and in so doing, to take into account the additional costs and expenses
that workers' compensation insurance carriers and pharmacies incur in
providing prescription drugs to individuals under the Labor Code and to
ensure the presence of a reliable network of pharmacy providers for
injured workers in Texas. That the 78th Legislature direct TWCC to pursue
efforts to streamline the procedures for presenting, processing, and
paying claims for prescription drugs under the Labor Code. That the 78th
Legislature direct the TWCC to implement this resolution in a
budgetneutral manner, and to employ, as appropriate, studies or other
research funded by collaborative efforts of workers' compensation
insurance carriers and pharmacy providers. That the secretary of state
forward an official copy of this resolution to the commissioner of TWCC.