Texas 2009 - 81st Regular

Texas Senate Bill SB946 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R3506 ALB-D
2	2	By: Deuell S.B. No. 946
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the Medicaid Drug Utilization Review Program and
8	8	prescription drug use under the Medicaid program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 531, Government Code, is
11	11	amended by adding Sections 531.0691, 531.0692, and 531.0693 to read
12	12	as follows:
13	13	Sec. 531.0691. MEDICAID DRUG UTILIZATION REVIEW PROGRAM:
14	14	DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section:
15	15	(1) "Medicaid Drug Utilization Review Program" means
16	16	the program operated by the vendor drug program to improve the
17	17	quality of pharmaceutical care under the Medicaid program.
18	18	(2) "Prospective drug use review" means the review of
19	19	a patient's drug therapy and prescription drug order or medication
20	20	order before dispensing or distributing a drug to the patient.
21	21	(3) "Retrospective drug use review" means the review
22	22	of prescription drug claims data to identify patterns of
23	23	prescribing.
24	24	(b) The commission shall provide for an increase in the
25	25	number and types of retrospective drug use reviews performed each
26	26	year under the Medicaid Drug Utilization Review Program, in
27	27	comparison to the number and types of reviews performed in the state
28	28	fiscal year ending August 31, 2009.
29	29	(c) In determining the number and types of drug use reviews
30	30	to be performed, the commission shall:
31	31	(1) allow for the repeat of retrospective drug use
32	32	reviews that address ongoing drug therapy problems and that, in
33	33	previous years, improved client outcomes and reduced Medicaid
34	34	spending;
35	35	(2) consider implementing disease-specific
36	36	retrospective drug use reviews that address ongoing drug therapy
37	37	problems in this state and that reduced Medicaid prescription drug
38	38	use expenditures in other states; and
39	39	(3) regularly examine Medicaid prescription drug
40	40	claims data to identify occurrences of potential drug therapy
41	41	problems that may be addressed by repeating successful
42	42	retrospective drug use reviews performed in this state and other
43	43	states.
44	44	(d) In addition to any other information required by federal
45	45	law, the commission shall include the following information in the
46	46	annual report regarding the Medicaid Drug Utilization Review
47	47	Program:
48	48	(1) a detailed description of the program's
49	49	activities; and
50	50	(2) estimates of cost savings anticipated to result
51	51	from the program's performance of prospective and retrospective
52	52	drug use reviews.
53	53	(e) The cost-saving estimates for prospective drug use
54	54	reviews under Subsection (d) must include savings attributed to
55	55	drug use reviews performed through the vendor drug program's
56	56	electronic claims processing system and clinical edits screened
57	57	through the prior authorization system implemented under Section
58	58	531.073.
59	59	(f) The commission shall post the annual report regarding
60	60	the Medicaid Drug Utilization Review Program on the commission's
61	61	website.
62	62	Sec. 531.0692. MEDICAID DRUG UTILIZATION REVIEW BOARD:
63	63	CONFLICTS OF INTEREST. (a) A member of the board of the Medicaid
64	64	Drug Utilization Review Program may not have a contractual
65	65	relationship, ownership interest, or other conflict of interest
66	66	with a pharmaceutical manufacturer or labeler or with an entity
67	67	engaged by the commission to assist in the administration of the
68	68	Medicaid Drug Utilization Review Program.
69	69	(b) The executive commissioner may implement this section
70	70	by adopting rules that identify prohibited relationships and
71	71	conflicts or requiring the board to develop a conflict-of-interest
72	72	policy that applies to the board.
73	73	Sec. 531.0693. PRESCRIPTION DRUG USE AND EXPENDITURE
74	74	PATTERNS. (a) The commission shall monitor and analyze
75	75	prescription drug use and expenditure patterns in the Medicaid
76	76	program. The commission shall identify the therapeutic
77	77	prescription drug classes and individual prescription drugs that
78	78	are most often prescribed to patients or that represent the
79	79	greatest expenditures. The analysis must consider the number of
80	80	claims, the total cost of paid claims, and the average cost per paid
81	81	claim after any prescription drug rebates.
82	82	(b) The commission shall post the data determined by the
83	83	commission under Subsection (a) on the commission's website and
84	84	update the information on a quarterly basis.
85	85	SECTION 2. If before implementing any provision of this Act
86	86	a state agency determines that a waiver or authorization from a
87	87	federal agency is necessary for implementation of that provision,
88	88	the agency affected by the provision shall request the waiver or
89	89	authorization and may delay implementing that provision until the
90	90	waiver or authorization is granted.
91	91	SECTION 3. This Act takes effect September 1, 2009.