82R3938 PMO-D
By: Nichols S.B. No. 996
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 1551.226 to read as follows:
Sec. 1551.226. 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) "Manufacturer" has the meaning assigned by Section
431.401, Health and Safety Code.
(3) "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) As directed by the committee established under Section
554.0055, Occupations Code, the board of trustees shall:
(1) adopt the list of eligible prescription pills as
established and updated by the committee; and
(2) make the list of eligible prescription pills and
educational materials developed under Section 554.0055,
Occupations Code, available to all persons covered by a health
benefit plan under the group benefits program.
(d) A manufacturer is not subject to criminal prosecution or
liable for damages in a civil action for an injury, death, or loss
to a person or of property arising out of the program established
under this section. This section may not be construed to create or
affect a cause of action against a manufacturer.
(e) 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) "Manufacturer" has the meaning assigned by Section
431.401, Health and Safety Code.
(3) "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) As directed by the committee established under Section
554.0055, Occupations Code, the trustee shall:
(1) adopt the list of eligible prescription pills as
established and updated by the committee; and
(2) make the list of eligible prescription pills and
educational materials developed under Section 554.0055,
Occupations Code, available to all persons covered by a health
benefit plan under the group program.
(d) A manufacturer is not subject to criminal prosecution or
liable for damages in a civil action for an injury, death, or loss
to a person or of property arising out of the program established
under this section. This section may not be construed to create or
affect a cause of action against a manufacturer.
(e) 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) "Manufacturer" has the meaning assigned by Section
431.401, Health and Safety Code.
(3) "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) As directed by the committee established under Section
554.0055, Occupations Code, the trustee shall:
(1) adopt the list of eligible prescription pills as
established and updated by the committee; and
(2) make the list of eligible prescription pills and
educational materials developed under Section 554.0055,
Occupations Code, available to all persons covered by a health
coverage plan under the uniform group coverage program.
(d) A manufacturer is not subject to criminal prosecution or
liable for damages in a civil action for an injury, death, or loss
to a person or of property arising out of the program established
under this section. This section may not be construed to create or
affect a cause of action against a manufacturer.
(e) 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) "Manufacturer" has the meaning assigned by Section
431.401, Health and Safety Code.
(3) "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) As directed by the committee established under Section
554.0055, Occupations Code, a system shall:
(1) adopt the list of eligible prescription pills as
established and updated by the committee; and
(2) make the list of eligible prescription pills and
educational materials developed under Section 554.0055,
Occupations Code, available to all persons covered by a health
benefit plan under a uniform program.
(d) A manufacturer is not subject to criminal prosecution or
liable for damages in a civil action for an injury, death, or loss
to a person or of property arising out of the program established
under this section. This section may not be construed to create or
affect a cause of action against a manufacturer.
(e) 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. Subchapter A, Chapter 554, Occupations Code, is
amended by adding Section 554.0055 to read as follows:
Sec. 554.0055. PILL SPLITTING COMMITTEE. (a) The board
shall establish a committee to prepare and periodically update for
purposes of Sections 1551.226, 1575.171, 1579.109, and 1601.111,
Insurance Code, a list of prescription pills that are appropriate
for splitting and would not be chemically destabilized or rendered
therapeutically ineffective if split.
(b) The committee shall consist of:
(1) a pharmacist member of the board who serves as
presiding officer of the committee;
(2) two community pharmacists;
(3) two health system pharmacists; and
(4) two physicians.
(c) The 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.
SECTION 6. The initial reports required by Sections
1551.226(e), 1575.171(e), 1579.109(e), and 1601.111(e), Insurance
Code, as added by this Act, are due not later than September 1,
2013.
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 2011-2012 plan year. A
plan year before 2011-2012 is governed by the law as it existed
immediately before September 1, 2011, 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 the 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, 2011.