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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 1551.226 to read as follows: |
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Sec. 1551.226. 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 that is appropriate for |
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splitting, as determined under Subsection (c), and is listed on the |
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applicable drug formulary, if any, described by Section 1551.218. |
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(2) "Manufacturer" has the meaning assigned by Section |
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431.401, Health and Safety Code. |
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(3) "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) As directed by the committee established under Section |
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554.0055, Occupations Code, the board of trustees shall: |
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(1) adopt the list of eligible prescription pills as |
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established and updated by the committee; and |
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(2) make the list of eligible prescription pills and |
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educational materials developed under Section 554.0055, |
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Occupations Code, available to all persons covered by a health |
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benefit plan under the group benefits program. |
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(d) A manufacturer is not subject to criminal prosecution or |
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liable for damages in a civil action for an injury, death, or loss |
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to a person or of property arising out of the program established |
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under this section. This section may not be construed to create or |
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affect a cause of action against a manufacturer. |
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(e) 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 that is appropriate for |
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splitting, as determined under Subsection (c), and is listed on the |
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applicable drug formulary, if any, described by Section 1575.170. |
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(2) "Manufacturer" has the meaning assigned by Section |
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431.401, Health and Safety Code. |
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(3) "Pill splitting" means dividing an eligible |
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prescription pill to obtain a prescribed dose. |
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(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 the group program who participate in the |
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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) As directed by the committee established under Section |
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554.0055, Occupations Code, the trustee shall: |
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(1) adopt the list of eligible prescription pills as |
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|
established and updated by the committee; and |
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(2) make the list of eligible prescription pills and |
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|
educational materials developed under Section 554.0055, |
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Occupations Code, available to all persons covered by a health |
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benefit plan under the group program. |
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(d) A manufacturer is not subject to criminal prosecution or |
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liable for damages in a civil action for an injury, death, or loss |
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to a person or of property arising out of the program established |
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under this section. This section may not be construed to create or |
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affect a cause of action against a manufacturer. |
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(e) 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 that is appropriate for |
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splitting, as determined under Subsection (c), and is listed on the |
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applicable drug formulary, if any, described by Section 1579.106. |
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(2) "Manufacturer" has the meaning assigned by Section |
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431.401, Health and Safety Code. |
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(3) "Pill splitting" means dividing an eligible |
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prescription pill to obtain a prescribed dose. |
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(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) As directed by the committee established under Section |
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554.0055, Occupations Code, the trustee shall: |
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(1) adopt the list of eligible prescription pills as |
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|
established and updated by the committee; and |
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|
(2) make the list of eligible prescription pills and |
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|
|
educational materials developed under Section 554.0055, |
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|
Occupations Code, available to all persons covered by a health |
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|
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coverage plan under the uniform group coverage program. |
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(d) A manufacturer is not subject to criminal prosecution or |
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|
liable for damages in a civil action for an injury, death, or loss |
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|
|
|
to a person or of property arising out of the program established |
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|
|
under this section. This section may not be construed to create or |
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|
|
affect a cause of action against a manufacturer. |
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|
(e) 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 program, and cost savings |
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resulting from the 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 that is appropriate for |
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|
|
splitting, as determined under Subsection (c), and is listed on the |
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applicable drug formulary, if any, established for group health |
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|
benefit coverage under a uniform program. |
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(2) "Manufacturer" has the meaning assigned by Section |
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|
|
431.401, Health and Safety Code. |
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|
|
(3) "Pill splitting" means dividing an eligible |
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|
|
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 |
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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) As directed by the committee established under Section |
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554.0055, Occupations Code, a system shall: |
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|
(1) adopt the list of eligible prescription pills as |
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|
established and updated by the committee; and |
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|
(2) make the list of eligible prescription pills and |
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|
|
educational materials developed under Section 554.0055, |
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|
Occupations Code, available to all persons covered by a health |
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|
|
benefit plan under a uniform program. |
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(d) A manufacturer is not subject to criminal prosecution or |
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|
liable for damages in a civil action for an injury, death, or loss |
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|
|
|
to a person or of property arising out of the program established |
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|
|
under this section. This section may not be construed to create or |
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|
|
affect a cause of action against a manufacturer. |
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|
(e) 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. Subchapter A, Chapter 554, Occupations Code, is |
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amended by adding Section 554.0055 to read as follows: |
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Sec. 554.0055. PILL SPLITTING COMMITTEE. (a) The board |
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shall establish a committee to prepare and periodically update for |
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purposes of Sections 1551.226, 1575.171, 1579.109, and 1601.111, |
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Insurance Code, a list of prescription pills that are appropriate |
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for splitting and would not be chemically destabilized or rendered |
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therapeutically ineffective if split. |
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(b) The committee shall consist of: |
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(1) a pharmacist member of the board who serves as |
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presiding officer of the committee; |
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(2) two community pharmacists; |
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(3) two health system pharmacists; and |
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(4) two physicians. |
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(c) The committee shall develop and make available for |
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distribution to program participants under Chapter 1551, 1575, |
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1579, or 1601, Insurance Code, educational materials that must |
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include: |
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(1) plain-language instruction about safely and |
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effectively splitting an eligible prescription pill; and |
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(2) information about: |
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(A) pills that are eligible for splitting; |
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(B) characteristics of an individual suited to |
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participate in a pill splitting program; and |
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(C) ways to enroll and participate in a pill |
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splitting program. |
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SECTION 6. The initial reports required by Sections |
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1551.226(e), 1575.171(e), 1579.109(e), and 1601.111(e), Insurance |
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Code, as added by this Act, are due not later than September 1, |
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2013. |
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SECTION 7. 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 2011-2012 plan year. A |
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plan year before 2011-2012 is governed by the law as it existed |
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immediately before September 1, 2011, and that law is continued in |
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effect for that purpose. |
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SECTION 8. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the 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, 2011. |