79R7498 KLA-F
By: Turner H.B. No. 3060
A BILL TO BE ENTITLED
AN ACT
relating to prescription drugs under the Medicaid vendor drug
program and other state health and human services programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.072, Government Code, is amended by
amending Subsection (c) and adding Subsections (g) and (h) to read
as follows:
(c) In making a decision regarding the placement of a drug
on each of the preferred drug lists, the commission shall consider:
(1) the recommendations of the Pharmaceutical and
Therapeutics Committee established under Section 531.074;
(2) the clinical efficacy of the drug;
(3) the price of competing drugs after deducting any
federal and state rebate amounts and the costs that would be
associated with requiring prior authorization for the drug; [and]
(4) program benefit offerings solely or in conjunction
with rebates and other pricing information;
(5) cost offsets to the state and cost savings to local
governments, including cost offsets and savings realized from
reductions in physician office visits, emergency room treatments,
and frequency or length of hospital stays that are projected to
result if the drug is included on a preferred drug list because the
drug, in comparison to alternate drugs, is more effective or causes
fewer side effects; and
(6) the impact of the drug on a patient's quality of
life.
(g) If the commission contracts with a private person to
assist the commission in preparing the preferred drug lists, the
contract must require the contractor to fully consider the overall
costs to the public of excluding a drug from a list. Costs of
excluding the drug that must be considered include:
(1) the purchase price of the drug; and
(2) the loss of:
(A) rebates paid by the manufacturer for the drug
as described by Section 531.070;
(B) program benefits offered by the manufacturer
as described by Section 531.070; and
(C) cost offsets and savings, including offsets
and savings realized from reductions in physician office visits,
emergency room treatments, and frequency or length of hospital
stays that are projected to result from better effectiveness or
reduced side effects from the drug in comparison to alternate
drugs.
(h) A contract described by Subsection (g) may not give the
contractor incentives to consider only a portion of the overall
costs to the public of excluding a drug from a preferred drug list
or discourage the contractor from considering the overall costs to
the public of excluding the drug.
SECTION 2. Section 531.073, Government Code, is amended by
adding Subsections (b-1), (g), and (h) to read as follows:
(b-1) The executive commissioner by rule shall establish
guidelines for the provision of a 72-hour supply of a drug as
required by Subsection (b)(3), including a definition of the
circumstances that constitute, or standards for determining
whether circumstances constitute, an emergency. A pharmacy that
complies with the guidelines must be reimbursed for dispensing a
72-hour supply of a drug.
(g) Prior authorization that is granted for a drug is valid
until the first anniversary of the date the prior authorization was
granted, or for a longer period as designated by the commission.
(h) The commission shall develop and implement procedures
to ensure that patients, health care providers, and pharmacists are
educated about the costs to the state of the prior authorization
requirements under this section and the clinical basis for those
requirements.
SECTION 3. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0731 to read as follows:
Sec. 531.0731. PRIOR AUTHORIZATION REQUIREMENTS FOR RESCUE
MEDICATIONS. (a) In this section, "rescue medication" means a drug
that is used in treating a patient with an illness or condition that
is chronic, is life-threatening, and requires complex medical
management strategies to provide quick relief from an acute symptom
of that illness or condition.
(b) Section 531.073 does not apply to a drug to which the
prior authorization requirements of that section would otherwise
apply if:
(1) the drug is a rescue medication prescribed by a
physician; and
(2) the manufacturer of the drug agrees to pay a
supplemental rebate under Section 531.070 in an amount that is at
least equal to the Medicaid rebates required under 42 U.S.C.
Section 1396r-8.
(c) With respect to a rescue medication that does not
qualify for an exemption under Subsection (b), the executive
commissioner may not adopt a rule and the commission may not
otherwise establish a policy that requires or has the effect of
requiring a patient to respond negatively to, or fail to improve on,
another medication before prior authorization for the rescue
medication will be granted if, in the professional judgment of the
prescribing physician, the rescue medication will:
(1) be more effective than the other drug in treating
the patient's illness or condition; or
(2) reduce the likelihood that the patient will
experience side effects or interactions that will negatively affect
the patient's health.
(d) Notwithstanding Section 531.073(g), prior
authorization that is granted for a rescue medication remains valid
for an indefinite period, and the physician or patient is not
required to obtain prior authorization for a subsequent
prescription of that medication if the medication is prescribed to
treat the illness or condition for which it was originally granted
prior authorization.
SECTION 4. Section 531.074(h), Government Code, is amended
to read as follows:
(h) In developing its recommendations for the preferred
drug lists, the committee shall consider the clinical efficacy,
safety, and cost-effectiveness, as determined under Sections
531.072(c)(3) and (5), of a product, [and] any program benefit
associated with the [a] product, and the impact of the product on a
patient's quality of life.
SECTION 5. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 6. This Act takes effect September 1, 2005.