87R18360 SCL-F
By: Oliverson, Bonnen, Collier, Canales, H.B. No. 18
Burrows, et al.
A BILL TO BE ENTITLED
AN ACT
relating to establishment of the prescription drug savings program
for certain uninsured individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. SHORT TITLE. This Act shall be known as "Texas
Cares."
SECTION 2. PRESCRIPTION DRUG SAVINGS PROGRAM. Subtitle C,
Title 2, Health and Safety Code, is amended by adding Chapter 65 to
read as follows:
CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
UNINSURED INDIVIDUALS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 65.001. DEFINITIONS. In this chapter:
(1) "Enrollee" means an individual enrolled in the
program.
(2) "Fund" means the trust fund established under
Section 65.101.
(3) "Pharmacy benefit manager" has the meaning
assigned by Section 4151.151, Insurance Code.
(4) "Prescription drug" has the meaning assigned by
Section 551.003, Occupations Code.
(5) "Program" means the prescription drug savings
program established under this chapter.
(6) "Uninsured individual" means an individual
without health benefit plan coverage for a prescription drug
benefit.
Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
chapter does not establish an entitlement to assistance in
obtaining benefits for uninsured individuals.
(b) The purpose of this chapter is to establish a program to
provide uninsured individuals access to prescription drug benefits
using money from the fund to pay an amount equal to the value of a
prescription drug rebate at the point of sale and returning that
rebate amount to the fund to ensure the amounts credited to the fund
equal the amounts paid from the fund.
(c) This chapter does not expand the Medicaid program.
Sec. 65.003. RULES. The executive commissioner shall adopt
rules as necessary to implement this chapter.
SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
DRUG SAVINGS PROGRAM
Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission
shall develop and design a prescription drug savings program that
partners with a pharmacy benefit manager to offer prescription
drugs at a discounted rate to uninsured individuals.
(b) In developing and implementing the program, the
commission shall ensure the program benefits do not include
prescription drugs used for the elective termination of a
pregnancy.
(c) The executive commissioner shall ensure the program is
designed to provide the greatest possible value to uninsured
individuals served by the program, while considering the adequacy
of the prescription drug formulary, net costs of the drugs to
enrollees, cost to the state, and other important factors
determined by the commission.
Sec. 65.052. GENERAL POWERS AND DUTIES OF COMMISSION
RELATED TO PROGRAM. (a) The commission shall oversee the
implementation of the program and coordinate the activities of each
state agency involved in that implementation.
(b) The commission shall design the program to be cost
neutral by collecting prescription drug rebates after using money
in the fund in amounts equal to the rebate amounts to purchase
prescription drugs.
(c) The commission shall develop procedures for accepting
applications for program enrollment, including a process to:
(1) determine eligibility, screening, and enrollment
procedures that allow applicants to self attest to the extent
authorized by federal law; and
(2) resolve disputes related to eligibility
determinations.
(d) The commission shall publish on an Internet website all
average consumer costs for each prescription drug available through
the program.
(e) The commission and the contracted pharmacy benefit
manager shall integrate manufacturer and other third-party patient
assistance programs into the program to the extent feasible. A
manufacturer or other third party may decline to link the
manufacturer's or third party's patient assistance program to the
program. The commission shall give preference to integrating
patient assistance programs by listing information on those patient
assistance programs in a central location on the Internet website
described by Subsection (d) that directs patients to those patient
assistance programs as appropriate.
(f) The commission shall ensure the program has access to an
adequate pharmacy network and give preference to conducting the
program using a state pharmaceutical assistance program.
(g) The commission is not required to enter into stand-alone
contracts under this chapter. The commission may add the program,
wholly or partly, to existing contracts to increase efficiency.
Sec. 65.053. PHARMACY BENEFIT MANAGER CONTRACT,
MONITORING, AND REPORTING REQUIREMENTS. (a) The commission shall
contract with a pharmacy benefit manager to provide discounted
prescription drugs to enrollees under the program.
(b) The commission shall monitor through reporting or other
methods the contracted pharmacy benefit manager to ensure
performance under the contract and quality delivery of services.
(c) The contracted pharmacy benefit manager shall report to
the commission on the commission's request information related to
the program, including information on rebate amounts, prescription
drug rates contracted with pharmacies, administrative costs, and
out-of-pocket costs paid by enrollees at the point of sale of the
prescription drugs.
Sec. 65.054. CONTRACT FUNCTIONS. (a) The commission may
contract with a third-party administrator or other entity to
perform any or all program functions for the commission under this
chapter and may delegate decisions about the policies of the
program to the third-party administrator or other entity.
(b) A third-party administrator or other entity may perform
tasks under a contract entered into under Subsection (a) that would
otherwise be performed by the commission.
Sec. 65.055. COMMUNITY OUTREACH CAMPAIGN. The commission
shall conduct or contract to conduct a community outreach and
education campaign in the form and manner determined by the
commission to provide information on the program's availability to
eligible individuals.
SUBCHAPTER C. TRUST FUND; PROGRAM SUSPENSION
Sec. 65.101. ESTABLISHMENT OF FUND. (a) A trust fund is
established outside the state treasury for the purposes of this
chapter only if this state receives federal money that may be used
for the purposes of this chapter and that federal money is directed
to be deposited to the credit of the fund as provided by law.
(b) The fund consists of:
(1) gifts, grants, and donations received by this
state for the purposes of the fund;
(2) legislative appropriations of money for the
purposes of this chapter;
(3) federal money available to this state that by law
may be used for the purposes of this chapter; and
(4) interest, dividends, and other income of the fund.
(c) The commission shall administer the fund as trustee for
the benefit of the program established by this chapter.
(d) Money in the fund may be used only to administer the
program and provide program services.
(e) The commission shall ensure money spent from the fund to
assist enrollees in purchasing prescription drugs is cost neutral
after collecting the prescription drug rebates under the program.
(f) The commission may solicit and accept gifts, grants, and
donations for the fund.
Sec. 65.102. FEDERAL MONEY REQUIRED. Notwithstanding any
other provision of this chapter, the commission may not implement
the program unless federal money is provided to this state and by
law made available for deposit to the credit of the fund.
Sec. 65.1025. INITIAL COSTS. (a) The commission may pay
the program's one-time start-up costs only with federal money in
the fund.
(b) This section expires September 1, 2025.
Sec. 65.103. SUSPENSION OF PROGRAM. On the fourth
anniversary of the date the program is established, the commission
shall suspend the program and seek legislative approval to continue
the program if the federal money in the fund available to be used
for the program's one-time start-up costs is depleted and the
ongoing costs of administering the program are not fully funded
through enrollee cost sharing.
SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided
by Subsection (b), an individual is eligible for benefits under the
program if the individual is:
(1) a resident of this state;
(2) a citizen or lawful permanent resident of the
United States; and
(3) uninsured, as determined by the commission.
(b) If the commission determines necessary, the commission
may consider an applicant's financial vulnerability as an
additional factor for determining program eligibility.
Sec. 65.152. COST SHARING. (a) To the extent necessary,
the commission shall require enrollees to share the cost of the
program, including requiring enrollees to pay a copayment at the
point of sale of a prescription drug.
(b) The commission must:
(1) allow an enrollee to pay all or part of the
enrollee's share from any source the enrollee selects; and
(2) accept another assistance program if that
assistance program wholly or partly covers the enrollee share of
the prescription drug cost.
(c) The commission shall require an enrollee to pay a
copayment to compensate the pharmacy, pharmacy benefit manager, and
commission for the costs of administering the program in accordance
with Subsection (d) and under the methodology determined by the
commission.
(d) Enrollees shall pay the costs of ongoing administration
of the program through an additional charge at the point of sale of
an eligible prescription drug only if the total number of enrollees
in the program allows for the additional charge to be an amount not
to exceed the lesser of:
(1) $4; or
(2) 10 percent of the total amount charged at the point
of sale for the prescription drug.
SUBCHAPTER E. OPERATION OF PROGRAM
Sec. 65.201. PROGRAM BENEFITS. The commission must approve
program benefits offered under this chapter. The commission shall
ensure the benefits comply with all applicable federal and state
laws, rules, and regulations.
Sec. 65.202. REPORTING. (a) A third-party administrator,
pharmacy benefit manager, or any other entity the commission
contracts with under Section 65.054 shall report to the commission
in the form and manner prescribed by the commission on the benefits
and services provided under the program.
(b) The commission shall establish a procedure to monitor
the provision of benefits and services under this chapter.
Sec. 65.203. FRAUD PREVENTION. The executive commissioner
by rule shall develop and implement fraud prevention and detection
for pharmacy benefit managers, contracted third parties, and other
entities involved in the program.
Sec. 65.204. ANNUAL PROGRAM REPORTS. Not later than
December 1 of each year, the commission shall provide a written
report to the governor, lieutenant governor, speaker of the house
of representatives, and standing committees of the legislature with
primary jurisdiction over the program. The report must include:
(1) a line-item list of all program administrative
costs incurred by the commission;
(2) the amount of the pharmacy benefit manager and
third-party administrator fees;
(3) the aggregate amounts of rebates anticipated and
received for the program; and
(4) other program expenditures as the commission
determines appropriate.
SECTION 3. INSULIN STUDY. (a) In this section,
"commission" means the Health and Human Services Commission.
(b) The commission shall conduct a study on the development
and implementation of the prescription drug savings program
established by Chapter 65, Health and Safety Code, as added by this
Act, in providing post-rebate insulin to enrollees. The commission
shall determine the effectiveness of the program in providing
insulin-related services to uninsured individuals in this state and
any legislative recommendations for improvements to the program.
(c) Not later than February 14, 2023, the commission shall
provide a written report of the results of the study conducted under
Subsection (b) of this section to the governor, lieutenant
governor, speaker of the house of representatives, and members of
the standing committees of the legislature with primary
jurisdiction over the commission. The study must include at least
six months of information on use by and cost to enrollees for
prescription insulin.
SECTION 4. GENERAL STUDY. (a) In this section,
"commission" means the Health and Human Services Commission.
(b) The commission shall conduct a study on the development
and implementation of the prescription drug savings program
established by Chapter 65, Health and Safety Code, as added by this
Act, in providing to enrollees all of the post-rebate formulary of
prescription drugs. The commission shall determine the
effectiveness of the program in providing insulin-related services
to uninsured individuals in this state and any legislative
recommendations for improvements to the program.
(c) Not later than February 14, 2025, the commission shall
provide a written report on the results of the study conducted under
Subsection (b) of this section to the governor, lieutenant
governor, speaker of the house of representatives, and standing
committees of the legislature with primary jurisdiction over the
commission. The study must include at least one year of information
on use by and cost to enrollees for all of the formulary of
prescription drugs.
SECTION 5. TRANSITION. The Health and Human Services
Commission is not required to submit the initial report under
Section 65.204, Health and Safety Code, as added by this Act, until
December 1, 2022.
SECTION 6. RULES. As soon as practicable after the
effective date of this Act, the executive commissioner of the
Health and Human Services Commission and any other state agency
designated by the executive commissioner shall adopt rules
necessary to implement Chapter 65, Health and Safety Code, as added
by this Act.
SECTION 7. EFFECTIVE DATE. This Act takes effect September
1, 2021.