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A BILL TO BE ENTITLED
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AN ACT
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relating to preferred drug lists adopted by the Health and Human |
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Services Commission and associated requirements regarding |
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supplemental rebates, prior authorization, and public |
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notification. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 531.071, Government Code, is amended by |
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amending Subsection (c) and adding Subsection (d) to read as |
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follows: |
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(c) General information about the aggregate costs of |
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different classes of drugs is not confidential under Subsection |
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(a), except that a drug name or information that could reveal a drug |
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name is confidential. |
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(d) Information about whether the commission and a |
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manufacturer or labeler reached or did not reach a supplemental |
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rebate agreement under Section 531.070 for a particular drug is not |
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confidential under Subsection (a). |
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SECTION 2. Section 531.072, Government Code, is amended by |
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adding Subsections (b-1), (b-2), and (c-1) to read as follows: |
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(b-1) Notwithstanding Subsection (b), the preferred drug |
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lists may contain: |
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(1) a drug provided by a manufacturer or labeler that |
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has not reached a supplemental rebate agreement with the commission |
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if the commission determines that inclusion of the drug on the |
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preferred drug lists will have no negative cost impact to the state; |
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or |
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(2) a drug provided by a manufacturer or labeler that |
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has reached an agreement with the commission to provide program |
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benefits in lieu of supplemental rebates, as described by Section |
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531.070. |
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(b-2) Consideration must be given to including all |
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strengths and dosage forms of a drug on the preferred drug lists. |
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(c-1) In addition to the considerations listed under |
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Subsection (c), the commission shall consider the inclusion of |
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multiple methods of delivery within each drug class, including |
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liquid, tablet, capsule, and orally disintegrating tablets. |
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SECTION 3. Section 531.073, Government Code, is amended by |
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adding Subsections (g) and (h) to read as follows: |
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(g) The commission shall ensure that requests for prior |
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authorization may be submitted by telephone, facsimile, or |
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electronic communications through the Internet. |
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(h) The commission shall provide an automated process that |
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may be used to assess a Medicaid recipient's medical and drug claim |
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history to determine whether the recipient's medical condition |
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satisfies the applicable criteria for dispensing a drug without an |
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additional prior authorization request. |
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SECTION 4. Section 531.074, Government Code, is amended by |
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amending Subsections (i) and (m) and adding Subsections (f-1) and |
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(i-1) to read as follows: |
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(f-1) The committee shall meet in public and shall permit |
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public comment before voting on any changes in the preferred drug |
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lists. Minutes of each meeting shall be made available to the |
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public not later than the 10th business day after the date the |
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minutes are approved. The committee may meet in executive session |
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to discuss confidential information as described by Subsection (i). |
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(i) The commission shall adopt rules governing the |
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operation of the committee, including rules governing the |
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procedures used by the committee for providing notice of a meeting |
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and rules prohibiting the committee from discussing confidential |
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information described by Section 531.071 in a public meeting. The |
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committee shall comply with the rules adopted under this subsection |
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and Subsection (i-1). |
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(i-1) In addition to the rules under Subsection (i), the |
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commission by rule shall require the committee or the committee's |
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designee to present a summary of any clinical efficacy and safety |
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information or analyses regarding a drug under consideration for a |
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preferred drug list that is provided to the committee by a private |
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entity that has contracted with the commission to provide the |
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information. The committee or the committee's designee shall |
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provide the summary in electronic form before the public meeting at |
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which consideration of the drug occurs. Confidential information |
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described by Section 531.071 must be omitted from the summary. The |
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summary must be posted on the commission's Internet website. |
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(m) The commission or the commission's agent shall publicly |
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disclose, immediately after the committee deliberations conclude, |
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each specific drug recommended for or against preferred drug list |
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status for each drug class included in the preferred drug list for |
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the Medicaid vendor drug program. The disclosure must be posted on |
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the commission's Internet website not later than the 10th business |
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day [made in writing] after the conclusion of committee |
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deliberations that result in recommendations made to the executive |
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commissioner regarding the placement of drugs on the preferred drug |
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list. The public disclosure must include: |
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(1) the general basis for the recommendation for each |
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drug class; and |
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(2) for each recommendation, whether a supplemental |
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rebate agreement or a program benefit agreement was reached under |
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Section 531.070. |
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SECTION 5. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0741 to read as follows: |
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Sec. 531.0741. PUBLICATION OF INFORMATION REGARDING |
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COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT. The |
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commission shall publish on the commission's Internet website any |
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decisions on preferred drug list placement, including: |
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(1) a list of drugs reviewed and the commission's |
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decision for or against placement on a preferred drug list of each |
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drug reviewed; |
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(2) for each recommendation, whether a supplemental |
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rebate agreement or a program benefit agreement was reached under |
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Section 531.070; and |
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(3) the rationale for any departure from a |
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recommendation of the pharmaceutical and therapeutics committee |
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established under Section 531.074. |
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SECTION 6. Not later than December 1, 2010, the executive |
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commissioner of the Health and Human Services Commission shall |
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implement Sections 531.073(g) and (h), Government Code, as added by |
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this Act. |
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SECTION 7. 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 8. This Act takes effect September 1, 2009. |