Texas 2009 - 81st Regular

Texas Senate Bill SB888 Compare Versions

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1	1	81R31786 PMO-D
2	2	By: Nelson S.B. No. 888
3	3	Substitute the following for S.B. No. 888:
4	4	By: Solomons C.S.S.B. No. 888
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to establishing a pill splitting program to reduce health
10	10	plan costs for certain public employees.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subchapter E, Chapter 1551, Insurance Code, is
13	13	amended by adding Section 1551.225 to read as follows:
14	14	Sec. 1551.225. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
15	15	(a) In this section:
16	16	(1) "Eligible prescription pill" means a prescription
17	17	medication delivered in pill form that is appropriate for
18	18	splitting, as determined under Subsection (c), and is listed on the
19	19	applicable drug formulary, if any, described by Section 1551.218.
20	20	(2) "Manufacturer" has the meaning assigned by Section
21	21	431.401, Health and Safety Code.
22	22	(3) "Pill splitting" means dividing an eligible
23	23	prescription pill to obtain a prescribed dose.
24	24	(b) The board of trustees by rule shall design and establish
25	25	a voluntary pill splitting program. The pill splitting program
26	26	must:
27	27	(1) include a copayment reduction incentive for
28	28	individuals covered by the group benefits program who participate
29	29	in the pill splitting program; and
30	30	(2) require an individual who participates in the pill
31	31	splitting program to:
32	32	(A) obtain a prescription for an eligible
33	33	prescription pill authorizing pill splitting from the prescribing
34	34	physician before participating; and
35	35	(B) personally split the eligible prescription
36	36	pill.
37	37	(c) As directed by the committee established under Section
38	38	554.0055, Occupations Code, the board of trustees shall:
39	39	(1) adopt the list of eligible prescription pills as
40	40	established and updated by the committee; and
41	41	(2) make the list of eligible prescription pills and
42	42	educational materials developed under Section 554.0055,
43	43	Occupations Code, available to all persons covered by a health
44	44	benefit plan under the group benefits program.
45	45	(d) A manufacturer is not subject to criminal prosecution or
46	46	liable for damages in a civil action for an injury, death, or loss
47	47	to a person or of property arising out of the program established
48	48	under this section. This section may not be construed to create or
49	49	affect a cause of action against a manufacturer.
50	50	(e) The board of trustees shall report at least annually to
51	51	the Legislative Budget Board and the governor on the design of the
52	52	pill splitting program, the medications included on the list of
53	53	eligible prescription pills, participation in the program, and cost
54	54	savings resulting from the program.
55	55	SECTION 2. Subchapter D, Chapter 1575, Insurance Code, is
56	56	amended by adding Section 1575.171 to read as follows:
57	57	Sec. 1575.171. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
58	58	(a) In this section:
59	59	(1) "Eligible prescription pill" means a prescription
60	60	medication delivered in pill form that is appropriate for
61	61	splitting, as determined under Subsection (c), and is listed on the
62	62	applicable drug formulary, if any, described by Section 1575.170.
63	63	(2) "Manufacturer" has the meaning assigned by Section
64	64	431.401, Health and Safety Code.
65	65	(3) "Pill splitting" means dividing an eligible
66	66	prescription pill to obtain a prescribed dose.
67	67	(b) The trustee by rule shall design and establish a
68	68	voluntary pill splitting program. The pill splitting program must:
69	69	(1) include a copayment reduction incentive for
70	70	individuals covered by the group program who participate in the
71	71	pill splitting program; and
72	72	(2) require an individual who participates in the pill
73	73	splitting program to:
74	74	(A) obtain a prescription for an eligible
75	75	prescription pill authorizing pill splitting from the prescribing
76	76	physician before participating; and
77	77	(B) personally split the eligible prescription
78	78	pill.
79	79	(c) As directed by the committee established under Section
80	80	554.0055, Occupations Code, the trustee shall:
81	81	(1) adopt the list of eligible prescription pills as
82	82	established and updated by the committee; and
83	83	(2) make the list of eligible prescription pills and
84	84	educational materials developed under Section 554.0055,
85	85	Occupations Code, available to all persons covered by a health
86	86	benefit plan under the group program.
87	87	(d) A manufacturer is not subject to criminal prosecution or
88	88	liable for damages in a civil action for an injury, death, or loss
89	89	to a person or of property arising out of the program established
90	90	under this section. This section may not be construed to create or
91	91	affect a cause of action against a manufacturer.
92	92	(e) The trustee shall report at least annually to the
93	93	Legislative Budget Board and the governor on the design of the pill
94	94	splitting program, medications included on the list of eligible
95	95	prescription pills, participation in the program, and cost savings
96	96	resulting from the program.
97	97	SECTION 3. Subchapter C, Chapter 1579, Insurance Code, is
98	98	amended by adding Section 1579.109 to read as follows:
99	99	Sec. 1579.109. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
100	100	(a) In this section:
101	101	(1) "Eligible prescription pill" means a prescription
102	102	medication delivered in pill form that is appropriate for
103	103	splitting, as determined under Subsection (c), and is listed on the
104	104	applicable drug formulary, if any, described by Section 1579.106.
105	105	(2) "Manufacturer" has the meaning assigned by Section
106	106	431.401, Health and Safety Code.
107	107	(3) "Pill splitting" means dividing an eligible
108	108	prescription pill to obtain a prescribed dose.
109	109	(b) The trustee by rule shall design and establish a
110	110	voluntary pill splitting program. The pill splitting program must:
111	111	(1) include a copayment reduction incentive for
112	112	individuals covered by a health coverage plan under this subchapter
113	113	who participate in the pill splitting program; and
114	114	(2) require an individual who participates in the pill
115	115	splitting program to:
116	116	(A) obtain a prescription for an eligible
117	117	prescription pill authorizing pill splitting from the prescribing
118	118	physician before participating; and
119	119	(B) personally split the eligible prescription
120	120	pill.
121	121	(c) As directed by the committee established under Section
122	122	554.0055, Occupations Code, the trustee shall:
123	123	(1) adopt the list of eligible prescription pills as
124	124	established and updated by the committee; and
125	125	(2) make the list of eligible prescription pills and
126	126	educational materials developed under Section 554.0055,
127	127	Occupations Code, available to all persons covered by a health
128	128	coverage plan under the uniform group coverage program.
129	129	(d) A manufacturer is not subject to criminal prosecution or
130	130	liable for damages in a civil action for an injury, death, or loss
131	131	to a person or of property arising out of the program established
132	132	under this section. This section may not be construed to create or
133	133	affect a cause of action against a manufacturer.
134	134	(e) The trustee shall report at least annually to the
135	135	Legislative Budget Board and the governor on the design of the pill
136	136	splitting program, medications included in the list of eligible
137	137	prescription pills, participation in the program, and cost savings
138	138	resulting from the program.
139	139	SECTION 4. Subchapter C, Chapter 1601, Insurance Code, is
140	140	amended by adding Section 1601.111 to read as follows:
141	141	Sec. 1601.111. ESTABLISHMENT OF PILL SPLITTING PROGRAM.
142	142	(a) In this section:
143	143	(1) "Eligible prescription pill" means a prescription
144	144	medication delivered in pill form that is appropriate for
145	145	splitting, as determined under Subsection (c), and is listed on the
146	146	applicable drug formulary, if any, established for group health
147	147	benefit coverage under a uniform program.
148	148	(2) "Manufacturer" has the meaning assigned by Section
149	149	431.401, Health and Safety Code.
150	150	(3) "Pill splitting" means dividing an eligible
151	151	prescription pill to obtain a prescribed dose.
152	152	(b) Each system by rule shall design and establish a
153	153	voluntary pill splitting program. The pill splitting program must:
154	154	(1) include a copayment reduction incentive for
155	155	individuals covered by a health benefit plan provided under this
156	156	chapter who participate in the program; and
157	157	(2) require an individual who participates in the
158	158	program to:
159	159	(A) obtain a prescription for an eligible
160	160	prescription pill authorizing pill splitting from the prescribing
161	161	physician before participating; and
162	162	(B) personally split the eligible prescription
163	163	pill.
164	164	(c) As directed by the committee established under Section
165	165	554.0055, Occupations Code, a system shall:
166	166	(1) adopt the list of eligible prescription pills as
167	167	established and updated by the committee; and
168	168	(2) make the list of eligible prescription pills and
169	169	educational materials developed under Section 554.0055,
170	170	Occupations Code, available to all persons covered by a health
171	171	benefit plan under a uniform program.
172	172	(d) A manufacturer is not subject to criminal prosecution or
173	173	liable for damages in a civil action for an injury, death, or loss
174	174	to a person or of property arising out of the program established
175	175	under this section. This section may not be construed to create or
176	176	affect a cause of action against a manufacturer.
177	177	(e) Each system shall report at least annually to the
178	178	Legislative Budget Board and the governor on the design of the pill
179	179	splitting program, medications included in the list of eligible
180	180	prescription pills, participation in the program, and cost savings
181	181	resulting from the program.
182	182	SECTION 5. Subchapter A, Chapter 554, Occupations Code, is
183	183	amended by adding Section 554.0055 to read as follows:
184	184	Sec. 554.0055. PILL SPLITTING COMMITTEE. (a) The board
185	185	shall establish a committee to prepare and periodically update for
186	186	purposes of Sections 1551.225, 1575.171, 1579.109, and 1601.111,
187	187	Insurance Code, a list of prescription pills that are appropriate
188	188	for splitting and would not be chemically destabilized or rendered
189	189	therapeutically ineffective if split.
190	190	(b) The committee shall consist of:
191	191	(1) a pharmacist member of the board who serves as
192	192	presiding officer of the committee;
193	193	(2) two community pharmacists;
194	194	(3) two health system pharmacists; and
195	195	(4) two physicians.
196	196	(c) The committee shall develop and make available for
197	197	distribution to program participants under Chapter 1551, 1575,
198	198	1579, or 1601, Insurance Code, educational materials that must
199	199	include:
200	200	(1) plain-language instruction about safely and
201	201	effectively splitting an eligible prescription pill; and
202	202	(2) information about:
203	203	(A) pills that are eligible for splitting;
204	204	(B) characteristics of an individual suited to
205	205	participate in a pill splitting program; and
206	206	(C) ways to enroll and participate in a pill
207	207	splitting program.
208	208	SECTION 6. The initial reports required by Sections
209	209	1551.225(e), 1575.171(e), 1579.109(e), and 1601.111(e), Insurance
210	210	Code, as added by this Act, are due not later than September 1,
211	211	2011.
212	212	SECTION 7. The changes in law made by this Act apply only to
213	213	health benefit plans provided under Chapters 1551, 1575, 1579, and
214	214	1601, Insurance Code, beginning with the 2009-2010 plan year. A
215	215	plan year before 2009-2010 is governed by the law as it existed
216	216	immediately before September 1, 2009, and that law is continued in
217	217	effect for that purpose.
218	218	SECTION 8. This Act takes effect immediately if it receives
219	219	a vote of two-thirds of all the members elected to each house, as
220	220	provided by Section 39, Article III, Texas Constitution. If this
221	221	Act does not receive the vote necessary for immediate effect, this
222	222	Act takes effect September 1, 2009.