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A BILL TO BE ENTITLED
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AN ACT
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relating to establishing a pill splitting program to reduce health |
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plan costs for certain public employees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter E, Chapter 1551, Insurance Code, is |
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amended by adding Section 1551.225 to read as follows: |
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Sec. 1551.225. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
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(a) In this section: |
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(1) "Eligible prescription pill" means a prescription |
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medication delivered in pill form and in a dosage that is |
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appropriate for splitting. |
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(2) "Pill splitting" means dividing an eligible |
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prescription pill to obtain a prescribed dose. |
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(b) The board of trustees by rule shall design and establish |
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a voluntary pill splitting program. The pill splitting program |
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must: |
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(1) include a copayment reduction incentive for |
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individuals covered by the group benefits program who participate |
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in the pill splitting program; and |
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(2) require an individual who participates in the pill |
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splitting program to: |
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(A) obtain a prescription for an eligible |
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prescription pill authorizing pill splitting from the prescribing |
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physician before participating; and |
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(B) personally split the eligible prescription |
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pill. |
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(c) The board of trustees shall establish a list of eligible |
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prescription pills and shall periodically update the list. |
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(d) The board of trustees shall report at least annually to |
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the Legislative Budget Board and the governor on the design of the |
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pill splitting program, the medications included on the list of |
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eligible prescription pills, participation in the program, and cost |
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savings resulting from the program. |
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SECTION 2. Subchapter D, Chapter 1575, Insurance Code, is |
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amended by adding Section 1575.171 to read as follows: |
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Sec. 1575.171. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
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(a) In this section: |
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(1) "Eligible prescription pill" means a prescription |
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|
medication delivered in pill form and in a dosage that is |
|
|
appropriate for splitting. |
|
|
(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 |
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|
(2) require an individual who participates in the pill |
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|
splitting program to: |
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|
(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
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|
(B) personally split the eligible prescription |
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pill. |
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(c) The trustee shall establish a list of eligible |
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prescription pills and shall periodically update the list. |
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(d) The trustee shall report at least annually to the |
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Legislative Budget Board and the governor on the design of the pill |
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splitting program, medications included on the list of eligible |
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prescription pills, participation in the program, and cost savings |
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resulting from the program. |
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SECTION 3. Subchapter C, Chapter 1579, Insurance Code, is |
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amended by adding Section 1579.109 to read as follows: |
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Sec. 1579.109. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
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(a) In this section: |
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(1) "Eligible prescription pill" means a prescription |
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|
medication delivered in pill form and in a dosage that is |
|
|
appropriate for splitting. |
|
|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
|
|
(b) The trustee by rule shall design and establish a |
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|
voluntary pill splitting program. The pill splitting program must: |
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(1) include a copayment reduction incentive for |
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individuals covered by a health coverage plan under this subchapter |
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who participate in the pill splitting program; and |
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(2) require an individual who participates in the pill |
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splitting program to: |
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(A) obtain a prescription for an eligible |
|
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prescription pill authorizing pill splitting from the prescribing |
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physician before participating; and |
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|
(B) personally split the eligible prescription |
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|
pill. |
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(c) The trustee shall establish a list of eligible |
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prescription pills and shall periodically update the list. |
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(d) The trustee shall report at least annually to the |
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Legislative Budget Board and the governor on the design of the pill |
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splitting program, medications included in the list of eligible |
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prescription pills, participation in the pill splitting program, |
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and cost savings resulting from the pill splitting program. |
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SECTION 4. Subchapter C, Chapter 1601, Insurance Code, is |
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amended by adding Section 1601.111 to read as follows: |
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Sec. 1601.111. ESTABLISHMENT OF PILL SPLITTING PROGRAM. |
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(a) In this section: |
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(1) "Eligible prescription pill" means a prescription |
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medication delivered in pill form and in a dosage that is |
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|
appropriate for splitting. |
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|
(2) "Pill splitting" means dividing an eligible |
|
|
prescription pill to obtain a prescribed dose. |
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|
(b) Each system by rule shall design and establish a |
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voluntary pill splitting program. The pill splitting program must: |
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(1) include a copayment reduction incentive for |
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individuals covered by a health benefit plan provided under this |
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chapter who participate in the program; and |
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(2) require an individual who participates in the |
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|
program to: |
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(A) obtain a prescription for an eligible |
|
|
prescription pill authorizing pill splitting from the prescribing |
|
|
physician before participating; and |
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|
(B) personally split the eligible prescription |
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|
pill. |
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(c) Each system shall establish a list of eligible |
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prescription pills and shall periodically update the list. |
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(d) Each system shall report at least annually to the |
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Legislative Budget Board and the governor on the design of the pill |
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splitting program, medications included in the list of eligible |
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prescription pills, participation in the program, and cost savings |
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resulting from the program. |
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SECTION 5. The initial reports required by Sections |
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1551.225(d), 1575.171(d), 1579.109(d), and 1601.111(d), Insurance |
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Code, as added by this Act, are due not later than December 1, 2010. |
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SECTION 6. The changes in law made by this Act apply only to |
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health benefit plans provided under Chapters 1551, 1575, 1579, and |
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1601, Insurance Code, beginning with the 2009-2010 plan year. A |
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plan year before 2009-2010 is governed by the law as it existed |
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immediately before September 1, 2009, and that law is continued in |
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effect for that purpose. |
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SECTION 7. This Act takes effect immediately if it receives |
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a vote of two-thirds of all members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2009. |