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79R7176 KLA-F
By: Miller H.B. No. 3391
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 531.070(l), Government Code, is amended
to read as follows:
(l) Each year the commission shall provide a written report
to the legislature and the governor. The report shall cover:
(1) the cost of administering the preferred drug lists
adopted under Section 531.072;
(2) an analysis of the utilization trends for medical
services provided by the state and any correlation to the preferred
drug lists;
(3) an analysis of the effect on health outcomes and
results for recipients; [and]
(4) statistical information related to the number of
approvals granted or denied; and
(5) an analysis of the effect during the preceding
year of the implementation of the Medicare Prescription Drug,
Improvement and Modernization Act of 2003 (Pub. L. No. 108-173) on
the preferred drug lists adopted under Section 531.072 and the
prior authorization requirements under Section 531.073, including
a determination of whether:
(A) any benefit remains from using the preferred
drug lists, given the eligibility of full-benefit dual eligible
individuals, as defined by 42 U.S.C. Section 1396u-5, for coverage
under a Medicare prescription drug plan; and
(B) any state contracts should be reconsidered,
given any reduction in the demand for prescription drugs under the
Medicaid vendor drug program that is caused by the shift of
full-benefit dual eligible individuals to the Medicare
prescription drug coverage.
SECTION 2. Section 531.071, Government Code, is amended by
adding Subsection (d) to read as follows:
(d) The commission or a health and human services agency may
not provide the Pharmaceutical and Therapeutics Committee with
access to any information that is confidential under Subsection
(a).
SECTION 3. Section 531.072, Government Code, is amended by
adding Subsections (g) and (h) to read as follows:
(g) Notwithstanding Section 2001.223, a decision by the
commission denying placement of a drug on a preferred drug list
adopted under this section is a decision in a contested case as
defined by Chapter 2001 and is subject to judicial review under the
substantial evidence rule in accordance with that chapter.
(h) The commission may not issue a physician or patient
advisory or directive discouraging the use of any drug on a
preferred drug list adopted under this section to treat a medical
condition for which the drug is indicated.
SECTION 4. Section 531.073, Government Code, is amended by
adding Subsections (b-1), (b-2), and (g) to read as follows:
(b-1) The commission shall develop criteria for use in
determining whether to grant prior authorization for a drug or
class of drugs. The Department of State Health Services' drug
utilization review board shall review and advise the commission
regarding the criteria. The commission may adopt and implement the
criteria only after the board has reviewed and advised the
commission regarding the criteria. A meeting of the drug
utilization review board at which the board will review proposed
criteria is subject to Chapter 551.
(b-2) The commission shall post on the Internet for
consumers and providers the criteria the commission will use for
each drug or class of drugs in determining whether to grant prior
authorization.
(g) If a prescribing physician or practitioner indicates
"dispense as written" in handwriting on the face of a prescription
or, for an electronic prescription, in an appropriate format, the
dispensing pharmacy may not substitute another drug without the
express permission of the prescribing physician or practitioner.
Notwithstanding any other law, the Medicaid vendor drug program,
the child health plan program, or another state program
administered by the commission or a health and human services
agency, as applicable:
(1) shall reimburse a dispensing pharmacy for a drug
dispensed for a recipient under the applicable program in
accordance with a "dispense as written" order; and
(2) may not require the dispensing pharmacy to obtain:
(A) prior authorization from the applicable
program or any program administrator; or
(B) confirmation from the prescribing physician
or practitioner by telephone or another means that the physician or
practitioner does not wish to substitute another medication for the
prescribed medication.
SECTION 5. Sections 531.074(c), (h), and (i), Government
Code, are amended to read as follows:
(c) In making appointments to the committee under
Subsection (b), the governor shall ensure that the committee
includes physicians and pharmacists who:
(1) represent different specialties and provide
services to all segments of the Medicaid program's diverse
population;
(2) have experience in either developing or practicing
under a preferred drug list; [and]
(3) do not have contractual relationships, ownership
interests, or other conflicts of interest with a pharmaceutical
manufacturer or labeler or with an entity engaged by the commission
to assist in the development of the preferred drug lists or the
administration of the prior authorization system; and
(4) participate in a medical or pharmaceutical
practice that involves caring for, or supervising the care of, at
least 150 Medicaid recipients.
(h) In developing its recommendations for the preferred
drug lists, the committee shall:
(1) consider the clinical efficacy, safety, and
cost-effectiveness and any program benefit associated with a
product; and
(2) for each class of drugs considered, solicit from
the Texas Medical Association written and verbal testimony from one
or more physicians specializing in the treatment of the diseases or
conditions the class of drugs is used to treat.
(i) The committee is subject to Chapter 551. The commission
shall adopt rules otherwise governing the operation of the
committee [, including rules governing the procedures used by the
committee for providing notice of a meeting and rules prohibiting
the committee from discussing confidential information described
by Section 531.071 in a public meeting]. The committee shall comply
with the rules adopted under this subsection.
SECTION 6. As soon as possible after the effective date of
this Act, the Health and Human Services Commission shall submit to
the Department of State Health Services' drug utilization review
board any criteria used by the commission on the effective date of
this Act in determining whether to grant prior authorization for a
drug or class of drugs under Section 531.073, Government Code. Not
later than November 1, 2005, the drug utilization review board
shall review and advise the commission regarding the criteria. The
commission shall revise the criteria as necessary after considering
the board's recommendations.
SECTION 7. 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 8. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2005.