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A BILL TO BE ENTITLED
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AN ACT
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relating to reimbursement under the Medicaid vendor drug program |
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for pharmacy care management services provided in connection with |
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specialty pharmacy products. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0464 to read as follows: |
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Sec. 32.0464. REIMBURSEMENT UNDER VENDOR DRUG PROGRAM FOR |
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CERTAIN PHARMACY CARE MANAGEMENT SERVICES. (a) In this section: |
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(1) "Pharmacy care management services" means |
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services provided by a pharmacy to support recipients of medical |
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assistance receiving treatment or therapy through a specialty |
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pharmacy product, including: |
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(A) significant caregiver and provider contact |
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and education regarding the relevant disease, disease prevention |
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and treatment, and drug indications and pharmacy counseling with |
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regard to benefits, risks, complications, and appropriate use of |
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the specialty pharmacy product; |
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(B) an explanation of existing guidelines to |
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providers; |
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(C) recipient compliance services, including |
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coordination of provider visits with delivery of the specialty |
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pharmacy product to the provider, compliance with the dosing |
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regimen, patient reminders, compilation of compliance data, and |
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assisting providers in development of a compliance program; and |
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(D) tracking services, including developing |
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ordering processes with a provider, screening referrals, and |
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tracking a patient's weight for dosing requirements. |
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(2) "Specialty pharmacy product" means a prescription |
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drug or therapy typically used to treat a chronic condition or |
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manage complex care issues, including: |
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(A) injection and infusion therapies; |
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(B) biotechnology drugs; |
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(C) high-cost therapies; and |
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(D) therapies requiring complex care. |
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(b) The department shall establish reimbursement rates |
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under the vendor drug program for pharmacies that provide pharmacy |
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care management services for recipients of medical assistance. The |
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reimbursement rates required by this subsection must be separate |
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from the reimbursement rates provided for the relevant specialty |
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pharmacy products. |
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(c) A pharmacy that seeks reimbursement under this section |
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shall provide verification that pharmacy care management services |
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were provided in connection with a specialty pharmacy product |
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provided by the pharmacy. |
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(d) The department shall consult with pharmacies that |
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provide pharmacy care management services to determine |
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reimbursement rates based on accurate costs of products, services, |
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and administrative costs described by this section. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. This Act takes effect September 1, 2009. |