82R6700 ALB-F
By: Hopson H.B. No. 1230
A BILL TO BE ENTITLED
AN ACT
relating to reimbursement under the Medicaid vendor drug program
for pharmacy care management services provided in connection with
specialty pharmacy products.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0464 to read as follows:
Sec. 32.0464. REIMBURSEMENT UNDER VENDOR DRUG PROGRAM FOR
CERTAIN PHARMACY CARE MANAGEMENT SERVICES. (a) In this section:
(1) "Pharmacy care management services" means
services provided by a pharmacy to support recipients of medical
assistance receiving treatment or therapy through a specialty
pharmacy product, including:
(A) significant caregiver and provider contact
and education regarding the relevant disease, disease prevention
and treatment, and drug indications and pharmacy counseling with
regard to benefits, risks, complications, and appropriate use of
the specialty pharmacy product;
(B) an explanation of existing guidelines to
providers;
(C) recipient compliance services, including
coordination of provider visits with delivery of the specialty
pharmacy product to the provider, compliance with the dosing
regimen, patient reminders, compilation of compliance data, and
assisting providers in development of a compliance program; and
(D) tracking services, including developing
ordering processes with a provider, screening referrals, and
tracking a patient's weight for dosing requirements.
(2) "Specialty pharmacy product" means a prescription
drug or therapy typically used to treat a chronic condition or
manage complex care issues, including:
(A) injection and infusion therapies;
(B) biotechnology drugs;
(C) high-cost therapies; and
(D) therapies requiring complex care.
(b) The department shall establish reimbursement rates
under the vendor drug program for pharmacies that provide pharmacy
care management services for recipients of medical assistance. The
reimbursement rates required by this subsection must be separate
from the reimbursement rates provided for the relevant specialty
pharmacy products.
(c) A pharmacy that seeks reimbursement under this section
shall provide verification that pharmacy care management services
were provided in connection with a specialty pharmacy product
provided by the pharmacy.
(d) The department shall consult with pharmacies that
provide pharmacy care management services to determine
reimbursement rates based on accurate costs of products, services,
and administrative costs described by this section.
SECTION 2. 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 3. This Act takes effect September 1, 2011.