By: Oliverson, Morales of Maverick H.B. No. 3026
A BILL TO BE ENTITLED
AN ACT
relating to the administration of a prescription drug manufacturer
or third-party prescription assistance program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 65.002(b), Health and Safety Code, is
amended to read as follows:
(b) The purpose of this chapter is to authorize the
commission 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.
SECTION 2. Section 65.051(a), Health and Safety Code, is
amended to read as follows:
(a) The commission may [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.
SECTION 3. Section 65.204, Health and Safety Code, is
amended to read as follows:
Sec. 65.204. ANNUAL PROGRAM REPORTS. Not later than
December 1 of each year following the first year in which the
program is established, 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 4. Subtitle C, Title 2, Health and Safety Code, is
amended by adding Chapter 66 to read as follows:
CHAPTER 66. PRESCRIPTION DRUG ASSISTANCE PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 66.001. DEFINITIONS. In this chapter:
(1) "Prescription drug" has the meaning assigned by
Section 551.003, Occupations Code.
(2) "Program" means the prescription drug assistance
program established under this chapter.
Sec. 66.002. CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
chapter does not establish an entitlement to assistance in
obtaining benefits for certain individuals.
(b) The purpose of this chapter is to authorize the
commission to establish a program to provide certain individuals
access to prescription drug benefits using a prescription drug
manufacturer or third-party prescription assistance programs.
(c) This chapter does not expand the Medicaid program.
Sec. 66.003. RULES. The executive commissioner may adopt
the rules necessary to implement this chapter.
SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
DRUG ASSISTANCE PROGRAM
Sec. 66.051. ESTABLISHMENT OF PROGRAM. (a) The commission
shall develop and design a prescription drug assistance program to
increase access to prescription drugs for certain individuals
through a prescription drug manufacturer or other third-party
patient assistance program.
(b) In developing and implementing the program, the
commission may not exclude from the program benefits prescription
drugs used for the elective termination of a pregnancy if the drug
is prescribed:
(1) for a purpose other than the elective termination
of a pregnancy; or
(2) to terminate a pregnancy in accordance with an
exception under Section 170A.002.
(c) The commission shall ensure the program is designed to
provide the greatest value to program enrollees by considering:
(1) the adequacy of prescription drugs available
through the program;
(2) the net costs of the drugs to enrollees;
(3) the cost to this state; and
(4) other important factors as determined by the
commission.
Sec. 66.052. GENERAL POWERS AND DUTIES OF COMMISSION. (a)
The commission shall oversee the implementation of the program and
develop procedures for accepting applications for program
enrollment.
(b) The commission shall list in a central location on the
commission's Internet website information that directs a patient to
the appropriate assistance available under the program.
(c) To the extent feasible, the commission shall integrate a
prescription drug manufacturer or third-party patient assistance
program into the prescription drug assistance program. A
prescription drug manufacturer or other third party may decline to
link the prescription drug manufacturer's or third party's patient
assistance program to the prescription drug assistance program.
Sec. 66.053. CONTRACT AND GRANT AUTHORITY. (a) The
commission may contract with a third-party administrator or other
entity to perform any or all of the commission's program duties
under this chapter.
(b) A third-party administrator or other entity under a
contract entered into under Subsection (a) may perform the actions
the commission would otherwise perform to implement the program.
(c) The commission may award grants to or enter into other
arrangements with a governmental entity or nonprofit organization
to implement this chapter.
Sec. 66.054. COMMUNITY OUTREACH AND EDUCATION CAMPAIGN. The
commission shall conduct a community outreach and education
campaign to provide information on the program's availability to
eligible individuals.
SUBCHAPTER C. FUNDING; PROGRAM SUSPENSION
Sec. 66.101. FUNDING. (a) The commission may accept and
use money to implement this chapter, including:
(1) gifts, grants, and donations;
(2) legislative appropriations; and
(3) federal money available under law.
(b) Money accepted under Subsection (a) may be used only to
administer the prescription drug assistance program and provide
program services.
Sec. 66.102. SUFFICIENT FUNDING REQUIRED. Notwithstanding
any other provision of this chapter, the commission is not required
to implement the program unless appropriated money is made
available for the program.
SUBCHAPTER D. PROGRAM ELIGIBILITY AND ENROLLEE REQUIREMENTS
Sec. 66.151. ELIGIBILITY CRITERIA. (a) Except as provided
by Subsection (b), an individual is eligible for benefits under the
program if the individual meets eligibility criteria as determined
by a prescription drug manufacturer or other third party's
prescription assistance program.
(b) The commission may identify additional factors the
program must consider for program eligibility.
SUBCHAPTER E. OPERATION OF PROGRAM
Sec. 66.201. 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 and rules.
Sec. 66.202. REPORT. (a) A third-party administrator or
other entity the commission contracts with under Section 66.053
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. 66.203. ANNUAL PROGRAM REPORT. 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, including costs incurred by a
third-party administrator or other entity;
(2) the aggregate amount of prescription drug cost
savings accrued under the program; and
(3) other program expenditures as the commission
determines appropriate.
SECTION 5. Section 65.102, Health and Safety Code, is
repealed.
SECTION 6. The Health and Human Services Commission is
required to implement a provision of this Act only if the
legislature appropriates money specifically for that purpose. If
the legislature does not appropriate money specifically for that
purpose, the Health and Human Services Commission may, but is not
required to, implement a provision of this Act using other
appropriations available for that purpose.
SECTION 7. 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 amended by this Act, and
Chapter 66, Health and Safety Code, as added by this Act.
SECTION 8. This Act takes effect September 1, 2023.