By: Zerwas (Senate Sponsor - Deuell) H.B. No. 2030
(In the Senate - Received from the House April 8, 2009;
April 15, 2009, read first time and referred to Committee on Health
and Human Services; May 8, 2009, reported favorably by the
following vote: Yeas 9, Nays 0; May 8, 2009, sent to printer.)
A BILL TO BE ENTITLED
AN ACT
relating to the Medicaid Drug Utilization Review Program and
prescription drug use under the Medicaid program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Sections 531.0691, 531.0692, and 531.0693 to read
as follows:
Sec. 531.0691. MEDICAID DRUG UTILIZATION REVIEW PROGRAM:
DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section:
(1) "Medicaid Drug Utilization Review Program" means
the program operated by the vendor drug program to improve the
quality of pharmaceutical care under the Medicaid program.
(2) "Prospective drug use review" means the review of
a patient's drug therapy and prescription drug order or medication
order before dispensing or distributing a drug to the patient.
(3) "Retrospective drug use review" means the review
of prescription drug claims data to identify patterns of
prescribing.
(b) The commission shall provide for an increase in the
number and types of retrospective drug use reviews performed each
year under the Medicaid Drug Utilization Review Program, in
comparison to the number and types of reviews performed in the state
fiscal year ending August 31, 2009.
(c) In determining the number and types of drug use reviews
to be performed, the commission shall:
(1) allow for the repeat of retrospective drug use
reviews that address ongoing drug therapy problems and that, in
previous years, improved client outcomes and reduced Medicaid
spending;
(2) consider implementing disease-specific
retrospective drug use reviews that address ongoing drug therapy
problems in this state and that reduced Medicaid prescription drug
use expenditures in other states; and
(3) regularly examine Medicaid prescription drug
claims data to identify occurrences of potential drug therapy
problems that may be addressed by repeating successful
retrospective drug use reviews performed in this state and other
states.
(d) In addition to any other information required by federal
law, the commission shall include the following information in the
annual report regarding the Medicaid Drug Utilization Review
Program:
(1) a detailed description of the program's
activities; and
(2) estimates of cost savings anticipated to result
from the program's performance of prospective and retrospective
drug use reviews.
(e) The cost-saving estimates for prospective drug use
reviews under Subsection (d) must include savings attributed to
drug use reviews performed through the vendor drug program's
electronic claims processing system and clinical edits screened
through the prior authorization system implemented under Section
531.073.
(f) The commission shall post the annual report regarding
the Medicaid Drug Utilization Review Program on the commission's
website.
Sec. 531.0692. MEDICAID DRUG UTILIZATION REVIEW BOARD:
CONFLICTS OF INTEREST. (a) A member of the board of the Medicaid
Drug Utilization Review Program may not have a contractual
relationship, ownership interest, or other conflict of interest
with a pharmaceutical manufacturer or labeler or with an entity
engaged by the commission to assist in the administration of the
Medicaid Drug Utilization Review Program.
(b) The executive commissioner may implement this section
by adopting rules that identify prohibited relationships and
conflicts or requiring the board to develop a conflict-of-interest
policy that applies to the board.
Sec. 531.0693. PRESCRIPTION DRUG USE AND EXPENDITURE
PATTERNS. (a) The commission shall monitor and analyze
prescription drug use and expenditure patterns in the Medicaid
program. The commission shall identify the therapeutic
prescription drug classes and individual prescription drugs that
are most often prescribed to patients or that represent the
greatest expenditures.
(b) The commission shall post the data determined by the
commission under Subsection (a) on the commission's website and
update the information on a quarterly basis.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect September 1, 2009.
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