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A BILL TO BE ENTITLED
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AN ACT
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relating to the Medicaid Drug Utilization Review Program and |
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prescription drug use under the Medicaid program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Sections 531.0691, 531.0692, and 531.0693 to read |
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as follows: |
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Sec. 531.0691. MEDICAID DRUG UTILIZATION REVIEW PROGRAM: |
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DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section: |
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(1) "Medicaid Drug Utilization Review Program" means |
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the program operated by the vendor drug program to improve the |
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quality of pharmaceutical care under the Medicaid program. |
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(2) "Prospective drug use review" means the review of |
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a patient's drug therapy and prescription drug order or medication |
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order before dispensing or distributing a drug to the patient. |
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(3) "Retrospective drug use review" means the review |
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of prescription drug claims data to identify patterns of |
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prescribing. |
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(b) The commission shall provide for an increase in the |
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number and types of retrospective drug use reviews performed each |
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year under the Medicaid Drug Utilization Review Program, in |
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comparison to the number and types of reviews performed in the state |
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fiscal year ending August 31, 2009. |
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(c) In determining the number and types of drug use reviews |
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to be performed, the commission shall: |
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(1) allow for the repeat of retrospective drug use |
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reviews that address ongoing drug therapy problems and that, in |
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previous years, improved client outcomes and reduced Medicaid |
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spending; |
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(2) consider implementing disease-specific |
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retrospective drug use reviews that address ongoing drug therapy |
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problems in this state and that reduced Medicaid prescription drug |
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use expenditures in other states; and |
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(3) regularly examine Medicaid prescription drug |
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claims data to identify occurrences of potential drug therapy |
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problems that may be addressed by repeating successful |
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retrospective drug use reviews performed in this state and other |
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states. |
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(d) In addition to any other information required by federal |
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law, the commission shall include the following information in the |
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annual report regarding the Medicaid Drug Utilization Review |
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Program: |
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(1) a detailed description of the program's |
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activities; and |
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(2) estimates of cost savings anticipated to result |
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from the program's performance of prospective and retrospective |
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drug use reviews. |
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(e) The cost-saving estimates for prospective drug use |
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reviews under Subsection (d) must include savings attributed to |
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drug use reviews performed through the vendor drug program's |
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electronic claims processing system and clinical edits screened |
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through the prior authorization system implemented under Section |
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531.073. |
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(f) The commission shall post the annual report regarding |
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the Medicaid Drug Utilization Review Program on the commission's |
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website. |
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Sec. 531.0692. MEDICAID DRUG UTILIZATION REVIEW BOARD: |
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CONFLICTS OF INTEREST. (a) A member of the board of the Medicaid |
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Drug Utilization Review Program may not have a contractual |
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relationship, ownership interest, or other conflict of interest |
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with a pharmaceutical manufacturer or labeler or with an entity |
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engaged by the commission to assist in the administration of the |
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Medicaid Drug Utilization Review Program. |
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(b) The executive commissioner may implement this section |
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by adopting rules that identify prohibited relationships and |
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conflicts or requiring the board to develop a conflict-of-interest |
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policy that applies to the board. |
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Sec. 531.0693. PRESCRIPTION DRUG USE AND EXPENDITURE |
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PATTERNS. (a) The commission shall monitor and analyze |
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prescription drug use and expenditure patterns in the Medicaid |
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program. The commission shall identify the therapeutic |
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prescription drug classes and individual prescription drugs that |
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are most often prescribed to patients or that represent the |
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greatest expenditures. The analysis must consider the number of |
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claims, the total cost of paid claims, and the average cost per paid |
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claim after any prescription drug rebates. |
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(b) The commission shall post the data determined by the |
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commission under Subsection (a) on the commission's website and |
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update the information on a quarterly basis. |
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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. |