81R1768 PMO-D
By: Nelson S.B. No. 888
A BILL TO BE ENTITLED
AN ACT
relating to establishing a pill splitting program to reduce health
plan costs for certain public employees.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 1551, Insurance Code, is
amended by adding Section 1551.225 to read as follows:
Sec. 1551.225. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
(a) In this section:
(1) "Eligible prescription pill" means a prescription
medication delivered in pill form and in a dosage that is
appropriate for splitting.
(2) "Pill splitting" means dividing an eligible
prescription pill to obtain a prescribed dose.
(b) The board of trustees by rule shall design and establish
a voluntary pill splitting program. The pill splitting program
must:
(1) include a copayment reduction incentive for
individuals covered by the group benefits program who participate
in the pill splitting program; and
(2) require an individual who participates in the pill
splitting program to:
(A) obtain a prescription for an eligible
prescription pill authorizing pill splitting from the prescribing
physician before participating; and
(B) personally split the eligible prescription
pill.
(c) The board of trustees shall establish a list of eligible
prescription pills and shall periodically update the list.
(d) The board of trustees shall report at least annually to
the Legislative Budget Board and the governor on the design of the
pill splitting program, the medications included on the list of
eligible prescription pills, participation in the program, and cost
savings resulting from the program.
SECTION 2. Subchapter D, Chapter 1575, Insurance Code, is
amended by adding Section 1575.171 to read as follows:
Sec. 1575.171. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
(a) In this section:
(1) "Eligible prescription pill" means a prescription
medication delivered in pill form and in a dosage that is
appropriate for splitting.
(2) "Pill splitting" means dividing an eligible
prescription pill to obtain a prescribed dose.
(b) The trustee by rule shall design and establish a
voluntary pill splitting program. The pill splitting program must:
(1) include a copayment reduction incentive for
individuals covered by the group program who participate in the
pill splitting program; and
(2) require an individual who participates in the pill
splitting program to:
(A) obtain a prescription for an eligible
prescription pill authorizing pill splitting from the prescribing
physician before participating; and
(B) personally split the eligible prescription
pill.
(c) The trustee shall establish a list of eligible
prescription pills and shall periodically update the list.
(d) The trustee shall report at least annually to the
Legislative Budget Board and the governor on the design of the pill
splitting program, medications included on the list of eligible
prescription pills, participation in the program, and cost savings
resulting from the program.
SECTION 3. Subchapter C, Chapter 1579, Insurance Code, is
amended by adding Section 1579.109 to read as follows:
Sec. 1579.109. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
(a) In this section:
(1) "Eligible prescription pill" means a prescription
medication delivered in pill form and in a dosage that is
appropriate for splitting.
(2) "Pill splitting" means dividing an eligible
prescription pill to obtain a prescribed dose.
(b) The trustee by rule shall design and establish a
voluntary pill splitting program. The pill splitting program must:
(1) include a copayment reduction incentive for
individuals covered by a health coverage plan under this subchapter
who participate in the pill splitting program; and
(2) require an individual who participates in the pill
splitting program to:
(A) obtain a prescription for an eligible
prescription pill authorizing pill splitting from the prescribing
physician before participating; and
(B) personally split the eligible prescription
pill.
(c) The trustee shall establish a list of eligible
prescription pills and shall periodically update the list.
(d) The trustee shall report at least annually to the
Legislative Budget Board and the governor on the design of the pill
splitting program, medications included in the list of eligible
prescription pills, participation in the pill splitting program,
and cost savings resulting from the pill splitting program.
SECTION 4. Subchapter C, Chapter 1601, Insurance Code, is
amended by adding Section 1601.111 to read as follows:
Sec. 1601.111. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
(a) In this section:
(1) "Eligible prescription pill" means a prescription
medication delivered in pill form and in a dosage that is
appropriate for splitting.
(2) "Pill splitting" means dividing an eligible
prescription pill to obtain a prescribed dose.
(b) Each system by rule shall design and establish a
voluntary pill splitting program. The pill splitting program must:
(1) include a copayment reduction incentive for
individuals covered by a health benefit plan provided under this
chapter who participate in the program; and
(2) require an individual who participates in the
program to:
(A) obtain a prescription for an eligible
prescription pill authorizing pill splitting from the prescribing
physician before participating; and
(B) personally split the eligible prescription
pill.
(c) Each system shall establish a list of eligible
prescription pills and shall periodically update the list.
(d) Each system shall report at least annually to the
Legislative Budget Board and the governor on the design of the pill
splitting program, medications included in the list of eligible
prescription pills, participation in the program, and cost savings
resulting from the program.
SECTION 5. The initial reports required by Sections
1551.225(d), 1575.171(d), 1579.109(d), and 1601.111(d), Insurance
Code, as added by this Act, are due not later than December 1, 2010.
SECTION 6. The changes in law made by this Act apply only to
health benefit plans provided under Chapters 1551, 1575, 1579, and
1601, Insurance Code, beginning with the 2009-2010 plan year. A
plan year before 2009-2010 is governed by the law as it existed
immediately before September 1, 2009, and that law is continued in
effect for that purpose.
SECTION 7. This Act takes effect immediately if it receives
a vote of two-thirds of all members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.