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


Senate Research CenterC.S.S.C.R. 48
By: Van de Putte
Business & Commerce
5-13-2003
Committee Report (Substituted)

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 and should not be in
excess of the amount charged for similar treatment of an injured
individual or an equivalent standard of living and paid by that individual
or by someone acting on that individual's behalf.  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 consider a rulemaking petition based on a study
funded by collaborative efforts of workers' compensation insurance
carriers and pharmacy providers and designed to determine pharmacy fees
paid by other payors and 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 six months
after a rulemaking petition is submitted to TWCC, 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 pharmacy fees paid by other payors and 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
budget-neutral manner, and to consider findings of studies or other
research funded by collaborative efforts of workers' compensation
insurance carriers and pharmacy providers; if such studies are not funded
by workers' compensation insurance carriers and pharmacy providers and
this resolution cannot be implemented in a budget-neutral manner, the
provisions of this resolution need not be implemented.  That the secretary
of state forward an official copy of this resolution to the chair and
executive director of TWCC.