Texas Senate Bill SB2262

Texas 2019 - 86th Regular

Caption

Relating to delivery of outpatient prescription drug benefits under certain public benefit programs, including Medicaid and the child health plan program.

Impact

By implementing SB2262, the Texas Health and Human Services Commission (HHSC) is expected to provide a more streamlined and transparent process for delivering these benefits. The bill specifically prohibits managed care organizations from creating outpatient pharmacy benefit plans after a specified transition period. This shift is seen as a way to enhance access to medications for recipients without imposing burdensome costs associated with pharmacy benefits managed under a capitation payment model.

Summary

SB2262 focuses on the provision of outpatient prescription drug benefits for certain public benefit programs in Texas, including Medicaid and the Child Health Plan Program. The bill mandates the use of a transparent fee-for-service delivery model rather than managed care organizations, aiming to eliminate additional fees that could inflate costs for beneficiaries. This change is set to commence on January 1, 2020, and involves amending several existing regulations under the Government and Human Resources Codes to ensure compliance with the new fee-for-service model.

Contention

Despite the positive intent behind SB2262, there are concerns regarding the potential impact on providers, particularly pharmacies that may become adversely affected by the shift away from managed care. Critics argue that while the bill aims to enhance patient access to necessary medications, it could lead to fiscal instability for some pharmacies that previously benefited from the managed care model. Balancing the needs of beneficiaries with the economic realities of pharmacy operations may be a challenging aspect of this implementation.