H.B. No. 2030
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, 531.0693, and
531.0694 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.
Sec. 531.0694. PERIOD OF VALIDITY FOR PRESCRIPTION. In its
rules and standards governing the vendor drug program, the
commission, to the extent allowed by federal law and laws
regulating the writing and dispensing of prescription medications,
shall ensure that a prescription written by an authorized health
care provider under the Medicaid program is valid for the lesser of
the period for which the prescription is written or one year. This
section does not apply to a prescription for a controlled
substance, as defined by Chapter 481, Health and Safety Code.
SECTION 2. Section 531.071, Government Code, is amended by
amending Subsection (c) and adding Subsection (d) to read as
follows:
(c) General information about the aggregate costs of
different classes of drugs is not confidential under Subsection
(a), except that a drug name or information that could reveal a drug
name is confidential.
(d) Information about whether the commission and a
manufacturer or labeler reached or did not reach a supplemental
rebate agreement under Section 531.070 for a particular drug is not
confidential under Subsection (a).
SECTION 3. Section 531.072, Government Code, is amended by
adding Subsections (b-1), (b-2), and (c-1) to read as follows:
(b-1) Notwithstanding Subsection (b), the preferred drug
lists may contain:
(1) a drug provided by a manufacturer or labeler that
has not reached a supplemental rebate agreement with the commission
if the commission determines that inclusion of the drug on the
preferred drug lists will have no negative cost impact to the state;
or
(2) a drug provided by a manufacturer or labeler that
has reached an agreement with the commission to provide program
benefits in lieu of supplemental rebates, as described by Section
531.070.
(b-2) Consideration must be given to including all
strengths and dosage forms of a drug on the preferred drug lists.
(c-1) In addition to the considerations listed under
Subsection (c), the commission shall consider the inclusion of
multiple methods of delivery within each drug class, including
liquid, tablet, capsule, and orally disintegrating tablets.
SECTION 4. Section 531.073, Government Code, is amended by
adding Subsections (g), (h), and (i) to read as follows:
(g) The commission shall ensure that requests for prior
authorization may be submitted by telephone, facsimile, or
electronic communications through the Internet.
(h) The commission shall provide an automated process that
may be used to assess a Medicaid recipient's medical and drug claim
history to determine whether the recipient's medical condition
satisfies the applicable criteria for dispensing a drug without an
additional prior authorization request.
(i) The commission shall study the costs and benefits of the
prior authorization process and methods to improve efficiency.
SECTION 5. Section 531.074, Government Code, is amended by
amending Subsections (i) and (m) and adding Subsections (f-1) and
(i-1) to read as follows:
(f-1) The committee shall meet in public and shall permit
public comment before voting on any changes in the preferred drug
lists. Minutes of each meeting shall be made available to the
public not later than the 10th business day after the date the
minutes are approved. The committee may meet in executive session
to discuss confidential information as described by Subsection (i).
(i) The commission shall adopt rules governing the
operation of the committee, including rules governing the
procedures used by the committee for providing notice of a meeting
and rules prohibiting the committee from discussing confidential
information described by Section 531.071 in a public meeting. The
committee shall comply with the rules adopted under this subsection
and Subsection (i-1).
(i-1) In addition to the rules under Subsection (i), the
commission by rule shall require the committee or the committee's
designee to present a summary of any clinical efficacy and safety
information or analyses regarding a drug under consideration for a
preferred drug list that is provided to the committee by a private
entity that has contracted with the commission to provide the
information. The committee or the committee's designee shall
provide the summary in electronic form before the public meeting at
which consideration of the drug occurs. Confidential information
described by Section 531.071 must be omitted from the summary. The
summary must be posted on the commission's Internet website.
(m) The commission or the commission's agent shall publicly
disclose, immediately after the committee deliberations conclude,
each specific drug recommended for or against preferred drug list
status for each drug class included in the preferred drug list for
the Medicaid vendor drug program. The disclosure must be posted on
the commission's Internet website not later than the 10th business
day [made in writing] after the conclusion of committee
deliberations that result in recommendations made to the executive
commissioner regarding the placement of drugs on the preferred drug
list. The public disclosure must include:
(1) the general basis for the recommendation for each
drug class; and
(2) for each recommendation, whether a supplemental
rebate agreement or a program benefit agreement was reached under
Section 531.070.
SECTION 6. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0741 to read as follows:
Sec. 531.0741. PUBLICATION OF INFORMATION REGARDING
COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT. The
commission shall publish on the commission's Internet website any
decisions on preferred drug list placement, including:
(1) a list of drugs reviewed and the commission's
decision for or against placement on a preferred drug list of each
drug reviewed;
(2) for each recommendation, whether a supplemental
rebate agreement or a program benefit agreement was reached under
Section 531.070; and
(3) the rationale for any departure from a
recommendation of the pharmaceutical and therapeutics committee
established under Section 531.074.
SECTION 7. Not later than December 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
implement Sections 531.073(g), (h), and (i), Government Code, as
added by this Act.
SECTION 8. 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 9. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2030 was passed by the House on April
8, 2009, by the following vote: Yeas 146, Nays 0, 1 present, not
voting; that the House refused to concur in Senate amendments to
H.B. No. 2030 on May 18, 2009, and requested the appointment of a
conference committee to consider the differences between the two
houses; and that the House adopted the conference committee report
on H.B. No. 2030 on May 27, 2009, by the following vote: Yeas 142,
Nays 0, 1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 2030 was passed by the Senate, with
amendments, on May 12, 2009, by the following vote: Yeas 31, Nays
0; at the request of the House, the Senate appointed a conference
committee to consider the differences between the two houses; and
that the Senate adopted the conference committee report on H.B. No.
2030 on May 30, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor