88R24363 JG-F
By: Klick H.B. No. 3286
Substitute the following for H.B. No. 3286:
By: Harless C.S.H.B. No. 3286
A BILL TO BE ENTITLED
AN ACT
relating to certain prescription drug benefits under the Medicaid
managed care program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 533, Government Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. PRESCRIPTION DRUG BENEFITS UNDER CERTAIN OUTPATIENT
PHARMACY BENEFIT PLANS
Sec. 533.071. APPLICABILITY OF SUBCHAPTER. This subchapter
applies only to an outpatient pharmacy benefit plan implemented by
a Medicaid managed care organization.
Sec. 533.072. PREFERRED DRUG LIST EXCEPTIONS.
Notwithstanding any other law, a Medicaid managed care organization
is not required to adhere to the preferred drug list adopted by the
commission under Section 531.072 and shall grant an exception to
the list with respect to a recipient if:
(1) the preferred drug:
(A) is contraindicated;
(B) will likely cause an adverse reaction in or
physical or mental harm to the recipient; or
(C) is expected to be ineffective based on the
known clinical characteristics of the recipient and the known
characteristics of the prescription drug regimen;
(2) the recipient previously discontinued taking the
preferred drug at any point in the recipient's clinical history and
for any length of time because the drug:
(A) was not effective;
(B) had a diminished effect; or
(C) resulted in an adverse event;
(3) the preferred drug is not in the best interest of
the recipient, based on clinical appropriateness, because the
recipient's use of the drug is expected to cause a significant
barrier to the recipient's adherence to or compliance with the
recipient's plan of care;
(4) the recipient was prescribed and is taking a
nonpreferred drug in the antidepressant or antipsychotic drug class
and the recipient:
(A) was prescribed the nonpreferred drug before
being discharged from an inpatient facility;
(B) is stable on the nonpreferred drug; and
(C) is at risk of experiencing complications from
switching from the nonpreferred drug to another drug;
(5) the preferred drug is not available for reasons
outside of the Medicaid managed care organization's control,
including because:
(A) the drug is in short supply according to the
Food and Drug Administration Drug Shortages Database; or
(B) the drug's manufacturer has placed the drug
on backorder or allocation; or
(6) the preferred drug is not available at a pharmacy
located within a 10-mile radius of the recipient.
Sec. 533.073. PREFERRED DRUG LIST; SEARCHABLE DATABASE OF
PREFERRED DRUGS AND RESTRICTIONS. The commission shall ensure
that:
(1) an Internet-based, searchable database is made
available through which a provider may search the applicable
preferred drug list adopted by the commission under Section 531.072
to easily determine whether a prescription drug or drug class is
subject to any prior authorization requirements, clinical edits, or
other clinical restrictions; and
(2) reasonable efforts are made to ensure the database
contains current information.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect September 1, 2023.