Texas 2009 - 81st Regular

Texas House Bill HB2030 Compare Versions

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1	1	H.B. No. 2030
2	2
3	3
4	4	AN ACT
5	5	relating to the Medicaid Drug Utilization Review Program and
6	6	prescription drug use under the Medicaid program.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Subchapter B, Chapter 531, Government Code, is
9	9	amended by adding Sections 531.0691, 531.0692, 531.0693, and
10	10	531.0694 to read as follows:
11	11	Sec. 531.0691. MEDICAID DRUG UTILIZATION REVIEW PROGRAM:
12	12	DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section:
13	13	(1) "Medicaid Drug Utilization Review Program" means
14	14	the program operated by the vendor drug program to improve the
15	15	quality of pharmaceutical care under the Medicaid program.
16	16	(2) "Prospective drug use review" means the review of
17	17	a patient's drug therapy and prescription drug order or medication
18	18	order before dispensing or distributing a drug to the patient.
19	19	(3) "Retrospective drug use review" means the review
20	20	of prescription drug claims data to identify patterns of
21	21	prescribing.
22	22	(b) The commission shall provide for an increase in the
23	23	number and types of retrospective drug use reviews performed each
24	24	year under the Medicaid Drug Utilization Review Program, in
25	25	comparison to the number and types of reviews performed in the state
26	26	fiscal year ending August 31, 2009.
27	27	(c) In determining the number and types of drug use reviews
28	28	to be performed, the commission shall:
29	29	(1) allow for the repeat of retrospective drug use
30	30	reviews that address ongoing drug therapy problems and that, in
31	31	previous years, improved client outcomes and reduced Medicaid
32	32	spending;
33	33	(2) consider implementing disease-specific
34	34	retrospective drug use reviews that address ongoing drug therapy
35	35	problems in this state and that reduced Medicaid prescription drug
36	36	use expenditures in other states; and
37	37	(3) regularly examine Medicaid prescription drug
38	38	claims data to identify occurrences of potential drug therapy
39	39	problems that may be addressed by repeating successful
40	40	retrospective drug use reviews performed in this state and other
41	41	states.
42	42	(d) In addition to any other information required by federal
43	43	law, the commission shall include the following information in the
44	44	annual report regarding the Medicaid Drug Utilization Review
45	45	Program:
46	46	(1) a detailed description of the program's
47	47	activities; and
48	48	(2) estimates of cost savings anticipated to result
49	49	from the program's performance of prospective and retrospective
50	50	drug use reviews.
51	51	(e) The cost-saving estimates for prospective drug use
52	52	reviews under Subsection (d) must include savings attributed to
53	53	drug use reviews performed through the vendor drug program's
54	54	electronic claims processing system and clinical edits screened
55	55	through the prior authorization system implemented under Section
56	56	531.073.
57	57	(f) The commission shall post the annual report regarding
58	58	the Medicaid Drug Utilization Review Program on the commission's
59	59	website.
60	60	Sec. 531.0692. MEDICAID DRUG UTILIZATION REVIEW BOARD:
61	61	CONFLICTS OF INTEREST. (a) A member of the board of the Medicaid
62	62	Drug Utilization Review Program may not have a contractual
63	63	relationship, ownership interest, or other conflict of interest
64	64	with a pharmaceutical manufacturer or labeler or with an entity
65	65	engaged by the commission to assist in the administration of the
66	66	Medicaid Drug Utilization Review Program.
67	67	(b) The executive commissioner may implement this section
68	68	by adopting rules that identify prohibited relationships and
69	69	conflicts or requiring the board to develop a conflict-of-interest
70	70	policy that applies to the board.
71	71	Sec. 531.0693. PRESCRIPTION DRUG USE AND EXPENDITURE
72	72	PATTERNS. (a) The commission shall monitor and analyze
73	73	prescription drug use and expenditure patterns in the Medicaid
74	74	program. The commission shall identify the therapeutic
75	75	prescription drug classes and individual prescription drugs that
76	76	are most often prescribed to patients or that represent the
77	77	greatest expenditures.
78	78	(b) The commission shall post the data determined by the
79	79	commission under Subsection (a) on the commission's website and
80	80	update the information on a quarterly basis.
81	81	Sec. 531.0694. PERIOD OF VALIDITY FOR PRESCRIPTION. In its
82	82	rules and standards governing the vendor drug program, the
83	83	commission, to the extent allowed by federal law and laws
84	84	regulating the writing and dispensing of prescription medications,
85	85	shall ensure that a prescription written by an authorized health
86	86	care provider under the Medicaid program is valid for the lesser of
87	87	the period for which the prescription is written or one year. This
88	88	section does not apply to a prescription for a controlled
89	89	substance, as defined by Chapter 481, Health and Safety Code.
90	90	SECTION 2. Section 531.071, Government Code, is amended by
91	91	amending Subsection (c) and adding Subsection (d) to read as
92	92	follows:
93	93	(c) General information about the aggregate costs of
94	94	different classes of drugs is not confidential under Subsection
95	95	(a), except that a drug name or information that could reveal a drug
96	96	name is confidential.
97	97	(d) Information about whether the commission and a
98	98	manufacturer or labeler reached or did not reach a supplemental
99	99	rebate agreement under Section 531.070 for a particular drug is not
100	100	confidential under Subsection (a).
101	101	SECTION 3. Section 531.072, Government Code, is amended by
102	102	adding Subsections (b-1), (b-2), and (c-1) to read as follows:
103	103	(b-1) Notwithstanding Subsection (b), the preferred drug
104	104	lists may contain:
105	105	(1) a drug provided by a manufacturer or labeler that
106	106	has not reached a supplemental rebate agreement with the commission
107	107	if the commission determines that inclusion of the drug on the
108	108	preferred drug lists will have no negative cost impact to the state;
109	109	or
110	110	(2) a drug provided by a manufacturer or labeler that
111	111	has reached an agreement with the commission to provide program
112	112	benefits in lieu of supplemental rebates, as described by Section
113	113	531.070.
114	114	(b-2) Consideration must be given to including all
115	115	strengths and dosage forms of a drug on the preferred drug lists.
116	116	(c-1) In addition to the considerations listed under
117	117	Subsection (c), the commission shall consider the inclusion of
118	118	multiple methods of delivery within each drug class, including
119	119	liquid, tablet, capsule, and orally disintegrating tablets.
120	120	SECTION 4. Section 531.073, Government Code, is amended by
121	121	adding Subsections (g), (h), and (i) to read as follows:
122	122	(g) The commission shall ensure that requests for prior
123	123	authorization may be submitted by telephone, facsimile, or
124	124	electronic communications through the Internet.
125	125	(h) The commission shall provide an automated process that
126	126	may be used to assess a Medicaid recipient's medical and drug claim
127	127	history to determine whether the recipient's medical condition
128	128	satisfies the applicable criteria for dispensing a drug without an
129	129	additional prior authorization request.
130	130	(i) The commission shall study the costs and benefits of the
131	131	prior authorization process and methods to improve efficiency.
132	132	SECTION 5. Section 531.074, Government Code, is amended by
133	133	amending Subsections (i) and (m) and adding Subsections (f-1) and
134	134	(i-1) to read as follows:
135	135	(f-1) The committee shall meet in public and shall permit
136	136	public comment before voting on any changes in the preferred drug
137	137	lists. Minutes of each meeting shall be made available to the
138	138	public not later than the 10th business day after the date the
139	139	minutes are approved. The committee may meet in executive session
140	140	to discuss confidential information as described by Subsection (i).
141	141	(i) The commission shall adopt rules governing the
142	142	operation of the committee, including rules governing the
143	143	procedures used by the committee for providing notice of a meeting
144	144	and rules prohibiting the committee from discussing confidential
145	145	information described by Section 531.071 in a public meeting. The
146	146	committee shall comply with the rules adopted under this subsection
147	147	and Subsection (i-1).
148	148	(i-1) In addition to the rules under Subsection (i), the
149	149	commission by rule shall require the committee or the committee's
150	150	designee to present a summary of any clinical efficacy and safety
151	151	information or analyses regarding a drug under consideration for a
152	152	preferred drug list that is provided to the committee by a private
153	153	entity that has contracted with the commission to provide the
154	154	information. The committee or the committee's designee shall
155	155	provide the summary in electronic form before the public meeting at
156	156	which consideration of the drug occurs. Confidential information
157	157	described by Section 531.071 must be omitted from the summary. The
158	158	summary must be posted on the commission's Internet website.
159	159	(m) The commission or the commission's agent shall publicly
160	160	disclose, immediately after the committee deliberations conclude,
161	161	each specific drug recommended for or against preferred drug list
162	162	status for each drug class included in the preferred drug list for
163	163	the Medicaid vendor drug program. The disclosure must be posted on
164	164	the commission's Internet website not later than the 10th business
165	165	day [made in writing] after the conclusion of committee
166	166	deliberations that result in recommendations made to the executive
167	167	commissioner regarding the placement of drugs on the preferred drug
168	168	list. The public disclosure must include:
169	169	(1) the general basis for the recommendation for each
170	170	drug class; and
171	171	(2) for each recommendation, whether a supplemental
172	172	rebate agreement or a program benefit agreement was reached under
173	173	Section 531.070.
174	174	SECTION 6. Subchapter B, Chapter 531, Government Code, is
175	175	amended by adding Section 531.0741 to read as follows:
176	176	Sec. 531.0741. PUBLICATION OF INFORMATION REGARDING
177	177	COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT. The
178	178	commission shall publish on the commission's Internet website any
179	179	decisions on preferred drug list placement, including:
180	180	(1) a list of drugs reviewed and the commission's
181	181	decision for or against placement on a preferred drug list of each
182	182	drug reviewed;
183	183	(2) for each recommendation, whether a supplemental
184	184	rebate agreement or a program benefit agreement was reached under
185	185	Section 531.070; and
186	186	(3) the rationale for any departure from a
187	187	recommendation of the pharmaceutical and therapeutics committee
188	188	established under Section 531.074.
189	189	SECTION 7. Not later than December 1, 2010, the executive
190	190	commissioner of the Health and Human Services Commission shall
191	191	implement Sections 531.073(g), (h), and (i), Government Code, as
192	192	added by this Act.
193	193	SECTION 8. If before implementing any provision of this Act
194	194	a state agency determines that a waiver or authorization from a
195	195	federal agency is necessary for implementation of that provision,
196	196	the agency affected by the provision shall request the waiver or
197	197	authorization and may delay implementing that provision until the
198	198	waiver or authorization is granted.
199	199	SECTION 9. This Act takes effect September 1, 2009.
200	200	______________________________ ______________________________
201	201	President of the Senate Speaker of the House
202	202	I certify that H.B. No. 2030 was passed by the House on April
203	203	8, 2009, by the following vote: Yeas 146, Nays 0, 1 present, not
204	204	voting; that the House refused to concur in Senate amendments to
205	205	H.B. No. 2030 on May 18, 2009, and requested the appointment of a
206	206	conference committee to consider the differences between the two
207	207	houses; and that the House adopted the conference committee report
208	208	on H.B. No. 2030 on May 27, 2009, by the following vote: Yeas 142,
209	209	Nays 0, 1 present, not voting.
210	210	______________________________
211	211	Chief Clerk of the House
212	212	I certify that H.B. No. 2030 was passed by the Senate, with
213	213	amendments, on May 12, 2009, by the following vote: Yeas 31, Nays
214	214	0; at the request of the House, the Senate appointed a conference
215	215	committee to consider the differences between the two houses; and
216	216	that the Senate adopted the conference committee report on H.B. No.
217	217	2030 on May 30, 2009, by the following vote: Yeas 31, Nays 0.
218	218	______________________________
219	219	Secretary of the Senate
220	220	APPROVED: __________________
221	221	Date
222	222	__________________
223	223	Governor