| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to establishing a pill splitting program to reduce health |
|
|
plan costs for certain public employees. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter E, Chapter 1551, Insurance Code, is |
|
|
amended by adding Section 1551.225 to read as follows: |
|
|
Sec. 1551.225. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
|
|
(a) In this section: |
|
|
(1) "Eligible prescription pill" means a prescription |
|
|
medication delivered in pill form that is appropriate for |
|
|
splitting, as determined under Subsection (c), and is listed on the |
|
|
applicable drug formulary, if any, described by Section 1551.218. |
|
|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
|
|
(b) The board of trustees by rule shall design and establish |
|
|
a voluntary pill splitting program. The pill splitting program |
|
|
must: |
|
|
(1) include a copayment reduction incentive for |
|
|
individuals covered by the group benefits program who participate |
|
|
in the pill splitting program; and |
|
|
(2) require an individual who participates in the pill |
|
|
splitting program to: |
|
|
(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
|
|
(B) personally split the eligible prescription |
|
|
pill. |
|
|
(c) With the assistance of the advisory committee |
|
|
established under Section 554.0055, Occupations Code, the board of |
|
|
trustees shall: |
|
|
(1) establish a list of eligible prescription pills; |
|
|
(2) periodically update the list of eligible |
|
|
prescription pills; and |
|
|
(3) make the list of eligible prescription pills |
|
|
available to all persons covered by a health benefit plan under the |
|
|
group benefits program. |
|
|
(d) The board of trustees shall report at least annually to |
|
|
the Legislative Budget Board and the governor on the design of the |
|
|
pill splitting program, the medications included on the list of |
|
|
eligible prescription pills, participation in the program, and cost |
|
|
savings resulting from the program. |
|
|
SECTION 2. Subchapter D, Chapter 1575, Insurance Code, is |
|
|
amended by adding Section 1575.171 to read as follows: |
|
|
Sec. 1575.171. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
|
|
(a) In this section: |
|
|
(1) "Eligible prescription pill" means a prescription |
|
|
medication delivered in pill form that is appropriate for |
|
|
splitting, as determined under Subsection (c), and is listed on the |
|
|
applicable drug formulary, if any, described by Section 1575.170. |
|
|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
|
|
(b) The trustee by rule shall design and establish a |
|
|
voluntary pill splitting program. The pill splitting program must: |
|
|
(1) include a copayment reduction incentive for |
|
|
individuals covered by the group program who participate in the |
|
|
pill splitting program; and |
|
|
(2) require an individual who participates in the pill |
|
|
splitting program to: |
|
|
(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
|
|
(B) personally split the eligible prescription |
|
|
pill. |
|
|
(c) With the assistance of the advisory committee |
|
|
established under Section 554.0055, Occupations Code, the trustee |
|
|
shall: |
|
|
(1) establish a list of eligible prescription pills; |
|
|
(2) periodically update the list of eligible |
|
|
prescription pills; and |
|
|
(3) make the list of eligible prescription pills |
|
|
available to all persons covered by a health benefit plan under the |
|
|
group program. |
|
|
(d) The trustee shall report at least annually to the |
|
|
Legislative Budget Board and the governor on the design of the pill |
|
|
splitting program, medications included on the list of eligible |
|
|
prescription pills, participation in the program, and cost savings |
|
|
resulting from the program. |
|
|
SECTION 3. Subchapter C, Chapter 1579, Insurance Code, is |
|
|
amended by adding Section 1579.109 to read as follows: |
|
|
Sec. 1579.109. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
|
|
(a) In this section: |
|
|
(1) "Eligible prescription pill" means a prescription |
|
|
medication delivered in pill form that is appropriate for |
|
|
splitting, as determined under Subsection (c), and is listed on the |
|
|
applicable drug formulary, if any, described by Section 1579.106. |
|
|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
|
|
(b) The trustee by rule shall design and establish a |
|
|
voluntary pill splitting program. The pill splitting program must: |
|
|
(1) include a copayment reduction incentive for |
|
|
individuals covered by a health coverage plan under this subchapter |
|
|
who participate in the pill splitting program; and |
|
|
(2) require an individual who participates in the pill |
|
|
splitting program to: |
|
|
(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
|
|
(B) personally split the eligible prescription |
|
|
pill. |
|
|
(c) With the assistance of the advisory committee |
|
|
established under Section 554.0055, Occupations Code, the trustee |
|
|
shall: |
|
|
(1) establish a list of eligible prescription pills; |
|
|
(2) periodically update the list of eligible |
|
|
prescription pills; and |
|
|
(3) make the list of eligible prescription pills |
|
|
available to all persons covered by a health coverage plan under the |
|
|
uniform group coverage program. |
|
|
(d) The trustee shall report at least annually to the |
|
|
Legislative Budget Board and the governor on the design of the pill |
|
|
splitting program, medications included in the list of eligible |
|
|
prescription pills, participation in the program, and cost savings |
|
|
resulting from the program. |
|
|
SECTION 4. Subchapter C, Chapter 1601, Insurance Code, is |
|
|
amended by adding Section 1601.111 to read as follows: |
|
|
Sec. 1601.111. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
|
|
(a) In this section: |
|
|
(1) "Eligible prescription pill" means a prescription |
|
|
medication delivered in pill form that is appropriate for |
|
|
splitting, as determined under Subsection (c), and is listed on the |
|
|
applicable drug formulary, if any, established for group health |
|
|
benefit coverage under a uniform program. |
|
|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
|
|
(b) Each system by rule shall design and establish a |
|
|
voluntary pill splitting program. The pill splitting program must: |
|
|
(1) include a copayment reduction incentive for |
|
|
individuals covered by a health benefit plan provided under this |
|
|
chapter who participate in the program; and |
|
|
(2) require an individual who participates in the |
|
|
program to: |
|
|
(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
|
|
(B) personally split the eligible prescription |
|
|
pill. |
|
|
(c) With the assistance of the advisory committee |
|
|
established under Section 554.0055, Occupations Code, a system |
|
|
shall: |
|
|
(1) establish a list of eligible prescription pills; |
|
|
(2) periodically update the list of eligible |
|
|
prescription pills; and |
|
|
(3) make the list of eligible prescription pills |
|
|
available to all persons covered by a health benefit plan under a |
|
|
uniform program. |
|
|
(d) Each system shall report at least annually to the |
|
|
Legislative Budget Board and the governor on the design of the pill |
|
|
splitting program, medications included in the list of eligible |
|
|
prescription pills, participation in the program, and cost savings |
|
|
resulting from the program. |
|
|
SECTION 5. The initial reports required by Sections |
|
|
1551.225(d), 1575.171(d), 1579.109(d), and 1601.111(d), Insurance |
|
|
Code, as added by this Act, are due not later than September 1, |
|
|
2011. |
|
|
SECTION 6. Subchapter A, Chapter 554, Occupations Code, is |
|
|
amended by adding Section 554.0055 to read as follows: |
|
|
Sec. 554.0055. PILL SPLITTING ADVISORY COMMITTEE. (a) The |
|
|
board shall establish an advisory committee to recommend to a |
|
|
governing body under Chapter 1551, 1575, 1579, or 1601, Insurance |
|
|
Code, prescription pills that are appropriate for splitting and |
|
|
would not be chemically destabilized or rendered therapeutically |
|
|
ineffective if split. |
|
|
(b) The advisory committee shall consist of: |
|
|
(1) a pharmacist member of the board who serves as |
|
|
presiding officer of the advisory committee; |
|
|
(2) two community pharmacists; |
|
|
(3) two health system pharmacists; and |
|
|
(4) two physicians. |
|
|
(c) The advisory committee shall develop and make available |
|
|
for distribution to program participants under Chapter 1551, 1575, |
|
|
1579, or 1601, Insurance Code, educational materials that must |
|
|
include: |
|
|
(1) plain-language instruction about safely and |
|
|
effectively splitting an eligible prescription pill; and |
|
|
(2) information about: |
|
|
(A) pills that are eligible for splitting; |
|
|
(B) characteristics of an individual suited to |
|
|
participate in a pill splitting program; and |
|
|
(C) ways to enroll and participate in a pill |
|
|
splitting program. |
|
|
(d) Section 2110.008, Government Code, does not apply to the |
|
|
advisory committee. |
|
|
SECTION 7. The changes in law made by this Act apply only to |
|
|
health benefit plans provided under Chapters 1551, 1575, 1579, and |
|
|
1601, Insurance Code, beginning with the 2009-2010 plan year. A |
|
|
plan year before 2009-2010 is governed by the law as it existed |
|
|
immediately before September 1, 2009, and that law is continued in |
|
|
effect for that purpose. |
|
|
SECTION 8. This Act takes effect immediately if it receives |
|
|
a vote of two-thirds of all 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, 2009. |