Texas House Bill HB437

Texas 2019 - 86th Regular

Caption

Relating to allowing Medicaid managed care organizations to adopt their own drug formularies.

Impact

The implementation of HB 437 is poised to result in significant changes to how medications are prescribed and made available to recipients of Medicaid in Texas. By allowing MCOs to create their own drug lists, there could be increased variation in available medications across different plans. This could affect provider choices and the treatment options available to patients, as each MCO may prioritize different drugs based on cost or therapeutic benefit. This could streamline processes for MCOs but may lead to disparities in patient care depending on their managed care provider.

Summary

House Bill 437 seeks to amend Texas law regarding the management of prescription drug formularies by allowing Medicaid managed care organizations (MCOs) to adopt their own formularies. This change pertains to the rules governing the Medicaid vendor drug program, which has traditionally had standardized drug lists set by the state. The bill introduces a section that specifically permits MCOs to implement individualized formularies, potentially diverging from a state-preferred drug list as long as compliance with existing laws is maintained.

Contention

The bill's proponents argue that enabling MCOs to adopt their own formularies can lead to more tailored patient care and improved management of pharmaceutical costs. However, there are concerns about the potential downsides, particularly related to patient access to necessary medications and the consistency of care across different MCOs. Critics fear that this could create a fragmented healthcare environment where patients may find critical drugs unavailable due to varying MCO policies. The debate thus centers around balancing cost management with ensuring comprehensive and equitable access to healthcare services.