H.B. No. 833
AN ACT
relating to certain pharmaceutical services for an injured employee
receiving workers' compensation medical benefits.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 408.028, Labor Code, is amended by
adding Subsection (e) to read as follows:
(e) Notwithstanding Subsection (b), the commission by rule
shall allow an employee to purchase a brand name drug rather than a
generic pharmaceutical medication or over-the-counter alternative
to a prescription medication if a health care provider prescribes a
generic pharmaceutical medication or an over-the-counter
alternative to a prescription medication. The employee shall be
responsible for paying the difference between the cost of the brand
name drug and the cost of the generic pharmaceutical medication or
of an over-the-counter alternative to a prescription medication.
The employee may not seek reimbursement for the difference in cost
from an insurance carrier and is not entitled to use the medical
dispute resolution provisions of Chapter 413 with regard to the
prescription. A payment described by this subsection by an
employee to a health care provider does not violate Section
413.042. This subsection does not affect the duty of a health care
provider to comply with the requirements of Subsection (b) when
prescribing medications or ordering over-the-counter alternatives
to prescription medications.
SECTION 2. (a) The Texas Workers' Compensation Commission
shall consider a rulemaking petition based on a study funded by
collaborative efforts of workers' compensation insurance carriers
and pharmacy providers. The study must be 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 the drugs to self-paying individuals
or individuals for whom payment is made under insurance coverage
other than workers' compensation insurance.
(b) The Texas Workers' Compensation Commission shall adopt,
not later than six months after the date a rulemaking petition is
submitted to the commission, rules that clearly define the
methodology for determining payment amounts for prescription drugs
under Subtitle A, Title 5, Labor Code. The rules described by this
section must take into account pharmacy fees paid by other payors
and the costs and expenses that workers' compensation insurance
carriers and pharmacies incur in providing prescription drugs to
individuals under that subtitle and must ensure the presence of a
reliable network of pharmacy providers for injured workers in this
state.
(c) The Texas Workers' Compensation Commission shall pursue
efforts to streamline the procedures for presenting, processing,
and paying claims for prescription drugs under Subtitle A, Title 5,
Labor Code, through the development of a system that is more
efficient than the system in place on the effective date of this
Act.
(d) The Texas Workers' Compensation Commission shall
implement the requirements of this section in a budget-neutral
manner and consider the findings of studies or other research
funded by collaborative efforts of workers' compensation insurance
carriers and pharmacy providers. If the studies are not funded by
workers' compensation insurance carriers and pharmacy providers
and this section cannot be implemented in a budget-neutral manner,
this section may not be implemented.
(e) This section expires December 31, 2004.
SECTION 3. (a) This Act takes effect September 1, 2003.
(b) The Texas Workers' Compensation Commission shall adopt
rules under Section 408.028(e), Labor Code, as added by this Act,
not later than March 1, 2004.
(c) In adopting rules under Section 408.028(e), Labor Code,
as added by this Act, the Texas Workers' Compensation Commission
shall make any changes to the commission's rules under 28 T.A.C.
Section 134.800 that are necessary to assist pharmacies in
complying with the change in law made by this Act.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 833 was passed by the House on May 10,
2003, by a non-record vote; and that the House concurred in Senate
amendments to H.B. No. 833 on May 29, 2003, by a non-record vote.
______________________________
Chief Clerk of the House
I certify that H.B. No. 833 was passed by the Senate, with
amendments, on May 27, 2003, by a viva-voce vote.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor