Texas 2021 - 87th Regular

Texas House Bill HB18 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 18
	1	+	By: Oliverson, et al. (Senate Sponsor - Kolkhorst) H.B. No. 18
	2	+	(In the Senate - Received from the House April 19, 2021;
	3	+	May 10, 2021, read first time and referred to Committee on Health &
	4	+	Human Services; May 20, 2021, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 8, Nays 0;
	6	+	May 20, 2021, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR H.B. No. 18 By: Hall
2	9
3	10
	11	+	A BILL TO BE ENTITLED
4	12		AN ACT
5	13		relating to establishment of the prescription drug savings program
6	14		for certain uninsured individuals.
7	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	16		SECTION 1. SHORT TITLE. This Act shall be known as "Texas
9	17		Cares."
10	18		SECTION 2. PRESCRIPTION DRUG SAVINGS PROGRAM. Subtitle C,
11	19		Title 2, Health and Safety Code, is amended by adding Chapter 65 to
12	20		read as follows:
13	21		CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
14	22		UNINSURED INDIVIDUALS
15	23		SUBCHAPTER A. GENERAL PROVISIONS
16	24		Sec. 65.001. DEFINITIONS. In this chapter:
17	25		(1) "Enrollee" means an individual enrolled in the
18	26		program.
19	27		(2) "Fund" means the trust fund established under
20	28		Section 65.101.
21	29		(3) "Pharmacy benefit manager" has the meaning
22	30		assigned by Section 4151.151, Insurance Code.
23	31		(4) "Prescription drug" has the meaning assigned by
24	32		Section 551.003, Occupations Code.
25	33		(5) "Program" means the prescription drug savings
26	34		program established under this chapter.
27	35		(6) "Uninsured individual" means an individual
28	36		without health benefit plan coverage for a prescription drug
29	37		benefit.
30	38		Sec. 65.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
31	39		chapter does not establish an entitlement to assistance in
32	40		obtaining benefits for uninsured individuals.
33	41		(b) The purpose of this chapter is to establish a program to
34	42		provide uninsured individuals access to prescription drug benefits
35	43		using money from the fund to pay an amount equal to the value of a
36	44		prescription drug rebate at the point of sale and returning that
37	45		rebate amount to the fund to ensure the amounts credited to the fund
38	46		equal the amounts paid from the fund.
39	47		(c) This chapter does not expand the Medicaid program.
40	48		Sec. 65.003. RULES. The executive commissioner shall adopt
41	49		rules as necessary to implement this chapter.
42	50		SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
43	51		DRUG SAVINGS PROGRAM
44	52		Sec. 65.051. ESTABLISHMENT OF PROGRAM. (a) The commission
45	53		shall develop and design a prescription drug savings program that
46	54		partners with a pharmacy benefit manager to offer prescription
47	55		drugs at a discounted rate to uninsured individuals.
48	56		(b) In developing and implementing the program, the
49	57		commission shall ensure the program benefits do not include
50	58		prescription drugs used for the elective termination of a
51	59		pregnancy.
52	60		(c) The executive commissioner shall ensure the program is
53	61		designed to provide the greatest possible value to uninsured
54	62		individuals served by the program, while considering the adequacy
55	63		of the prescription drug formulary, net costs of the drugs to
56	64		enrollees, cost to the state, and other important factors
57	65		determined by the commission.
58	66		Sec. 65.052. GENERAL POWERS AND DUTIES OF COMMISSION
59	67		RELATED TO PROGRAM. (a) The commission shall oversee the
60	68		implementation of the program and coordinate the activities of each
61	69		state agency involved in that implementation.
62	70		(b) The commission shall design the program to be cost
63	71		neutral by collecting prescription drug rebates after using money
64	72		in the fund in amounts equal to the rebate amounts to purchase
65	73		prescription drugs.
66	74		(c) The commission shall develop procedures for accepting
67	75		applications for program enrollment, including a process to:
68	76		(1) determine eligibility, screening, and enrollment
69	77		procedures that allow applicants to self attest to the extent
70	78		authorized by federal law; and
71	79		(2) resolve disputes related to eligibility
72	80		determinations.
73	81		(d) The commission shall publish on an Internet website all
74	82		average consumer costs for each prescription drug available through
75	83		the program.
76	84		(e) The commission and the contracted pharmacy benefit
77	85		manager shall integrate manufacturer and other third-party patient
78	86		assistance programs into the program to the extent feasible. A
79	87		manufacturer or other third party may decline to link the
80	88		manufacturer's or third party's patient assistance program to the
81	89		program. The commission shall give preference to integrating
82	90		patient assistance programs by listing information on those patient
83	91		assistance programs in a central location on the Internet website
84	92		described by Subsection (d) that directs patients to those patient
85	93		assistance programs as appropriate.
86	94		(f) The commission shall ensure the program has access to an
87	95		adequate pharmacy network and give preference to conducting the
88	96		program using a state pharmaceutical assistance program.
89	97		(g) The commission is not required to enter into stand-alone
90	98		contracts under this chapter. The commission may add the program,
91	99		wholly or partly, to existing contracts to increase efficiency.
92	100		Sec. 65.053. PHARMACY BENEFIT MANAGER CONTRACT,
93	101		MONITORING, AND REPORTING REQUIREMENTS. (a) The commission shall
94	102		contract with a pharmacy benefit manager to provide discounted
95	103		prescription drugs to enrollees under the program.
96	104		(b) The commission shall monitor through reporting or other
97	105		methods the contracted pharmacy benefit manager to ensure
98	106		performance under the contract and quality delivery of services.
99	107		(c) The contracted pharmacy benefit manager shall report to
100	108		the commission on the commission's request information related to
101	109		the program, including information on rebate amounts, prescription
102	110		drug rates contracted with pharmacies, administrative costs, and
103	111		out-of-pocket costs paid by enrollees at the point of sale of the
104	112		prescription drugs.
105	113		Sec. 65.054. CONTRACT FUNCTIONS. (a) The commission may
106	114		contract with a third-party administrator or other entity to
107	115		perform any or all program functions for the commission under this
108	116		chapter.
109	117		(b) A third-party administrator or other entity may perform
110	118		tasks under a contract entered into under Subsection (a) that would
111	119		otherwise be performed by the commission.
112	120		Sec. 65.055. COMMUNITY OUTREACH CAMPAIGN. The commission
113	121		shall conduct or contract to conduct a community outreach and
114	122		education campaign in the form and manner determined by the
115	123		commission to provide information on the program's availability to
116	124		eligible individuals.
117	125		SUBCHAPTER C. TRUST FUND; PROGRAM SUSPENSION
118	126		Sec. 65.101. ESTABLISHMENT OF FUND. (a) A trust fund is
119	127		established outside the state treasury for the purposes of this
120	128		chapter.
121	129		(b) The fund consists of:
122	130		(1) gifts, grants, and donations received by this
123	131		state for the purposes of the fund;
124	132		(2) legislative appropriations of money for the
125	133		purposes of this chapter;
126	134		(3) federal money available to this state that by law
127	135		may be used for the purposes of this chapter; and
128	136		(4) interest, dividends, and other income of the fund.
129	137		(c) The commission shall administer the fund as trustee for
130	138		the benefit of the program established by this chapter.
131	139		(d) Money in the fund may be used only to administer the
132	140		program and provide program services.
133	141		(e) The commission shall ensure money spent from the fund to
134	142		assist enrollees in purchasing prescription drugs is cost neutral
135	143		after collecting the prescription drug rebates under the program.
136	144		(f) The commission may solicit and accept gifts, grants, and
137	145		donations for the fund.
138	146		Sec. 65.102. SUFFICIENT FUNDING REQUIRED. Notwithstanding
139	147		any other provision of this chapter, the commission is not required
140	148		to implement the program unless money is provided and by law made
141	149		available for deposit to the credit of the fund.
142	150		Sec. 65.103. SUSPENSION OF PROGRAM. On the fourth
143	151		anniversary of the date the program is established, the commission
144	152		shall suspend the program and seek legislative approval to continue
145	153		the program unless the ongoing costs of administering the program
146	154		are fully funded through enrollee cost sharing.
147	155		SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
148	156		Sec. 65.151. ELIGIBILITY CRITERIA. (a) Except as provided
149	157		by Subsection (b), an individual is eligible for benefits under the
150	158		program if the individual is:
151	159		(1) a resident of this state;
152	160		(2) a citizen or lawful permanent resident of the
153	161		United States; and
154	162		(3) uninsured, as determined by the commission.
155	163		(b) If the commission determines necessary, the commission
156	164		may consider an applicant's financial vulnerability as an
157	165		additional factor for determining program eligibility.
158	166		Sec. 65.152. COST SHARING. (a) To the extent necessary,
159	167		the commission shall require enrollees to share the cost of the
160	168		program, including requiring enrollees to pay a copayment at the
161	169		point of sale of a prescription drug.
162	170		(b) The commission must:
163	171		(1) allow an enrollee to pay all or part of the
164	172		enrollee's share from any source the enrollee selects; and
165	173		(2) accept another assistance program if that
166	174		assistance program wholly or partly covers the enrollee share of
167	175		the prescription drug cost.
168	176		(c) The commission shall require an enrollee to pay a
169	177		copayment to compensate the pharmacy, pharmacy benefit manager, and
170	178		commission for the costs of administering the program in accordance
171	179		with Subsection (d) and under the methodology determined by the
172	180		commission.
173	181		(d) Enrollees shall pay the costs of ongoing administration
174	182		of the program through an additional charge at the point of sale of
175	183		an eligible prescription drug only if the total number of enrollees
176	184		in the program allows for the additional charge to be an amount not
177	185		to exceed the lesser of:
178	186		(1) an amount similar to the amount charged for a
179	187		prescription drug in other state pharmaceutical assistance
180	188		programs administered by the commission; or
181	189		(2) 10 percent of the total amount charged at the point
182	190		of sale for the prescription drug.
183	191		SUBCHAPTER E. OPERATION OF PROGRAM
184	192		Sec. 65.201. PROGRAM BENEFITS. The commission must approve
185	193		program benefits offered under this chapter. The commission shall
186	194		ensure the benefits comply with all applicable federal and state
187	195		laws, rules, and regulations.
188	196		Sec. 65.202. REPORTING. (a) A third-party administrator,
189	197		pharmacy benefit manager, or any other entity the commission
190	198		contracts with under Section 65.054 shall report to the commission
191	199		in the form and manner prescribed by the commission on the benefits
192	200		and services provided under the program.
193	201		(b) The commission shall establish a procedure to monitor
194	202		the provision of benefits and services under this chapter.
195	203		Sec. 65.203. FRAUD PREVENTION. The executive commissioner
196	204		by rule shall develop and implement fraud prevention and detection
197	205		for pharmacy benefit managers, contracted third parties, and other
198	206		entities involved in the program.
199	207		Sec. 65.204. ANNUAL PROGRAM REPORTS. Not later than
200	208		December 1 of each year, the commission shall provide a written
201	209		report to the governor, lieutenant governor, speaker of the house
202	210		of representatives, and standing committees of the legislature with
203	211		primary jurisdiction over the program. The report must include:
204	212		(1) a line-item list of all program administrative
205	213		costs incurred by the commission;
206	214		(2) the amount of the pharmacy benefit manager and
207	215		third-party administrator fees;
208	216		(3) the aggregate amounts of rebates anticipated and
209	217		received for the program; and
210	218		(4) other program expenditures as the commission
211	219		determines appropriate.
212	220		SECTION 3. INSULIN STUDY. (a) In this section,
213	221		"commission" means the Health and Human Services Commission.
214	222		(b) The commission shall conduct a study on the development
215	223		and implementation of the prescription drug savings program
216	224		established by Chapter 65, Health and Safety Code, as added by this
217	225		Act, in providing post-rebate insulin to enrollees. The commission
218	226		shall determine the effectiveness of the program in providing
219	227		insulin-related services to uninsured individuals in this state and
220	228		any legislative recommendations for improvements to the program.
221	229		(c) Not later than February 14, 2023, the commission shall
222	230		provide a written report of the results of the study conducted under
223	231		Subsection (b) of this section to the governor, lieutenant
224	232		governor, speaker of the house of representatives, and members of
225	233		the standing committees of the legislature with primary
226	234		jurisdiction over the commission. The study must include at least
227	235		six months of information on use by and cost to enrollees for
228	236		prescription insulin.
229	237		SECTION 4. GENERAL STUDY. (a) In this section,
230	238		"commission" means the Health and Human Services Commission.
231	239		(b) The commission shall conduct a study on the development
232	240		and implementation of the prescription drug savings program
233	241		established by Chapter 65, Health and Safety Code, as added by this
234	242		Act, in providing to enrollees all of the post-rebate formulary of
235	243		prescription drugs. The commission shall determine the
236	244		effectiveness of the program in providing prescription
237	245		drug-related services to uninsured individuals in this state and
238	246		any legislative recommendations for improvements to the program.
239	247		(c) Not later than February 14, 2025, the commission shall
240	248		provide a written report on the results of the study conducted under
241	249		Subsection (b) of this section to the governor, lieutenant
242	250		governor, speaker of the house of representatives, and standing
243	251		committees of the legislature with primary jurisdiction over the
244	252		commission. The study must include at least one year of information
245	253		on use by and cost to enrollees for all of the formulary of
246	254		prescription drugs.
247	255		SECTION 5. TRANSITION. (a) The Health and Human Services
248	256		Commission is not required to submit the initial report under
249	257		Section 65.204, Health and Safety Code, as added by this Act, until
250	258		December 1, 2022.
251	259		(b) The Health and Human Services Commission is required to
252	260		implement a provision of this Act only if the legislature
253	261		appropriates money specifically for that purpose. If the
254	262		legislature does not appropriate money specifically for that
255	263		purpose, the Health and Human Services Commission may, but is not
256	264		required to, implement a provision of this Act using other
257	265		appropriations available for that purpose.
258	266		SECTION 6. RULES. As soon as practicable after the
259	267		effective date of this Act, the executive commissioner of the
260	268		Health and Human Services Commission and any other state agency
261	269		designated by the executive commissioner shall adopt rules
262	270		necessary to implement Chapter 65, Health and Safety Code, as added
263	271		by this Act.
264	272		SECTION 7. EFFECTIVE DATE. This Act takes effect September
265	273		1, 2021.
266		-	______________________________ ______________________________
267		-	President of the Senate Speaker of the House
268		-	I certify that H.B. No. 18 was passed by the House on April
269		-	15, 2021, by the following vote: Yeas 144, Nays 1, 1 present, not
270		-	voting; and that the House concurred in Senate amendments to H.B.
271		-	No. 18 on May 28, 2021, by the following vote: Yeas 146, Nays 0, 1
272		-	present, not voting.
273		-	______________________________
274		-	Chief Clerk of the House
275		-	I certify that H.B. No. 18 was passed by the Senate, with
276		-	amendments, on May 22, 2021, by the following vote: Yeas 28, Nays
277		-	2.
278		-	______________________________
279		-	Secretary of the Senate
280		-	APPROVED: __________________
281		-	Date
282		-	__________________
283		-	Governor
	274	+	* * * * *