By: Nelson S.B. No. 888
(In the Senate - Filed February 17, 2009; March 9, 2009,
read first time and referred to Committee on State Affairs;
March 26, 2009, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 9, Nays 0; March 26, 2009,
sent to printer.)
COMMITTEE SUBSTITUTE FOR S.B. No. 888 By: Lucio
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 that is appropriate for
splitting, as determined under Subsection (c), and is listed on the
applicable drug formulary, if any, described by Section 1551.218.
(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) With the assistance of the advisory committee
established under Section 554.0055, Occupations Code, the board of
trustees shall:
(1) establish a list of eligible prescription pills;
(2) periodically update the list of eligible
prescription pills; and
(3) make the list of eligible prescription pills
available to all persons covered by a health benefit plan under the
group benefits program.
(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 that is appropriate for
splitting, as determined under Subsection (c), and is listed on the
applicable drug formulary, if any, described by Section 1575.170.
(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) With the assistance of the advisory committee
established under Section 554.0055, Occupations Code, the trustee
shall:
(1) establish a list of eligible prescription pills;
(2) periodically update the list of eligible
prescription pills; and
(3) make the list of eligible prescription pills
available to all persons covered by a health benefit plan under the
group program.
(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 that is appropriate for
splitting, as determined under Subsection (c), and is listed on the
applicable drug formulary, if any, described by Section 1579.106.
(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) With the assistance of the advisory committee
established under Section 554.0055, Occupations Code, the trustee
shall:
(1) establish a list of eligible prescription pills;
(2) periodically update the list of eligible
prescription pills; and
(3) make the list of eligible prescription pills
available to all persons covered by a health coverage plan under the
uniform group coverage program.
(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 program, and cost savings
resulting from the 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 that is appropriate for
splitting, as determined under Subsection (c), and is listed on the
applicable drug formulary, if any, established for group health
benefit coverage under a uniform program.
(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) With the assistance of the advisory committee
established under Section 554.0055, Occupations Code, a system
shall:
(1) establish a list of eligible prescription pills;
(2) periodically update the list of eligible
prescription pills; and
(3) make the list of eligible prescription pills
available to all persons covered by a health benefit plan under a
uniform program.
(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 September 1,
2011.
SECTION 6. Subchapter A, Chapter 554, Occupations Code, is
amended by adding Section 554.0055 to read as follows:
Sec. 554.0055. PILL SPLITTING ADVISORY COMMITTEE. (a) The
board shall establish an advisory committee to recommend to a
governing body under Chapter 1551, 1575, 1579, or 1601, Insurance
Code, prescription pills that are appropriate for splitting and
would not be chemically destabilized or rendered therapeutically
ineffective if split.
(b) The advisory committee shall consist of:
(1) a pharmacist member of the board who serves as
presiding officer of the advisory committee;
(2) two community pharmacists;
(3) two health system pharmacists; and
(4) two physicians.
(c) The advisory committee shall develop and make available
for distribution to program participants under Chapter 1551, 1575,
1579, or 1601, Insurance Code, educational materials that must
include:
(1) plain-language instruction about safely and
effectively splitting an eligible prescription pill; and
(2) information about:
(A) pills that are eligible for splitting;
(B) characteristics of an individual suited to
participate in a pill splitting program; and
(C) ways to enroll and participate in a pill
splitting program.
(d) Section 2110.008, Government Code, does not apply to the
advisory committee.
SECTION 7. 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 8. 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.
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