Texas 2023 - 88th Regular

Texas House Bill HB3286 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 3286
2	2
3	3
4	4	AN ACT
5	5	relating to prescription drug benefits under Medicaid and the child
6	6	health plan program.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Subchapter B, Chapter 531, Government Code, is
9	9	amended by adding Section 531.0691 to read as follows:
10	10	Sec. 531.0691. VENDOR DRUG PROGRAM INCLUSION. (a) The
11	11	commission shall ensure that the vendor drug program includes all
12	12	drugs and national drug codes made available under the federal
13	13	Medicaid Drug Rebate Program if a certificate of information form
14	14	to request the drug's inclusion in the vendor drug program has been
15	15	submitted to the commission and:
16	16	(1) approved by the commission; or
17	17	(2) subject to Subsection (b), is pending review by
18	18	the commission.
19	19	(b) On receipt of a certificate of information form to
20	20	request the addition to the Texas Drug Code Index of a drug that is
21	21	available under the federal Medicaid Drug Rebate Program, the
22	22	commission shall, if the commission determines that the drug is
23	23	appropriate for dispensing through an outpatient pharmacy,
24	24	provisionally make the drug available under the vendor drug program
25	25	for a period that expires on the earlier of:
26	26	(1) the 90th day after the date the form was submitted;
27	27	or
28	28	(2) the date the commission makes a determination
29	29	regarding whether to approve or deny the drug's inclusion on the
30	30	vendor drug program formulary.
31	31	(c) The commission shall:
32	32	(1) denote the provisional availability of a drug
33	33	under this section; and
34	34	(2) remove a drug made provisionally available under
35	35	the vendor drug program:
36	36	(A) on the expiration of the 90-day period
37	37	prescribed by Subsection (b)(1); or
38	38	(B) if applicable, on the date the commission
39	39	denies the drug's inclusion on the vendor drug program formulary.
40	40	SECTION 2. Chapter 533, Government Code, is amended by
41	41	adding Subchapter C to read as follows:
42	42	SUBCHAPTER C. PRESCRIPTION DRUG BENEFITS UNDER CERTAIN OUTPATIENT
43	43	PHARMACY BENEFIT PLANS
44	44	Sec. 533.071. PREFERRED DRUG LIST EXCEPTIONS. (a) The
45	45	commission shall adopt rules allowing exceptions to the preferred
46	46	drug list if:
47	47	(1) the drug required under the preferred drug list:
48	48	(A) is contraindicated;
49	49	(B) will likely cause an adverse reaction in or
50	50	physical or mental harm to the recipient; or
51	51	(C) is expected to be ineffective based on the
52	52	known clinical characteristics of the recipient and the known
53	53	characteristics of the prescription drug regimen;
54	54	(2) the recipient previously discontinued taking the
55	55	preferred drug at any point in the recipient's clinical history and
56	56	for any length of time because the drug:
57	57	(A) was not effective;
58	58	(B) had a diminished effect; or
59	59	(C) resulted in an adverse event;
60	60	(3) the recipient was prescribed and is taking a
61	61	nonpreferred drug in the antidepressant or antipsychotic drug class
62	62	and the recipient:
63	63	(A) was prescribed the nonpreferred drug before
64	64	being discharged from an inpatient facility;
65	65	(B) is stable on the nonpreferred drug; and
66	66	(C) is at risk of experiencing complications from
67	67	switching from the nonpreferred drug to another drug; or
68	68	(4) the preferred drug is not available for reasons
69	69	outside of the Medicaid managed care organization's control,
70	70	including because:
71	71	(A) the drug is in short supply according to the
72	72	Food and Drug Administration Drug Shortages Database; or
73	73	(B) the drug's manufacturer has placed the drug
74	74	on backorder or allocation.
75	75	(b) An exception provided under this section does not
76	76	subject the Medicaid managed care plan to liquidated damages for
77	77	failing to comply with the preferred drug list.
78	78	SECTION 3. Section 531.072, Government Code, is amended by
79	79	adding Subsections (b-3), (g), and (h) to read as follows:
80	80	(b-3) Notwithstanding Subsection (b), the preferred drug
81	81	lists must contain all therapeutic equivalents for a generic drug
82	82	on the preferred drug list.
83	83	(g) The commission shall develop an expedited review
84	84	process to consider requests from managed care organizations and
85	85	providers to add drugs to the preferred drug list.
86	86	(h) The commission shall grant temporary non-preferred
87	87	status to new drugs that are available but have not yet been
88	88	reviewed by the drug utilization review board and establish
89	89	criteria for authorizing drugs with temporary non-preferred
90	90	status.
91	91	SECTION 4. Section 531.073(b), Government Code, is amended
92	92	to read as follows:
93	93	(b) The commission shall establish procedures for the prior
94	94	authorization requirement under the Medicaid vendor drug program to
95	95	ensure that the requirements of 42 U.S.C. Section 1396r-8(d)(5) and
96	96	its subsequent amendments are met. Specifically, the procedures
97	97	must ensure that:
98	98	(1) [a prior authorization requirement is not imposed
99	99	for a drug before the drug has been considered at a meeting of the
100	100	Drug Utilization Review Board under Section 531.0736;
101	101	[(2)] there will be a response to a request for prior
102	102	authorization by telephone or other telecommunications device
103	103	within 24 hours after receipt of a request for prior authorization;
104	104	and
105	105	(2) [(3)] a 72-hour supply of the drug prescribed will
106	106	be provided in an emergency or if the commission does not provide a
107	107	response within the time required by Subdivision (1) [(2)].
108	108	SECTION 5. Sections 531.0736(c) and (d), Government Code,
109	109	are amended to read as follows:
110	110	(c) The executive commissioner shall determine the
111	111	composition of the board, which must:
112	112	(1) comply with applicable federal law, including 42
113	113	C.F.R. Section 456.716;
114	114	(2) include three [two] representatives of managed
115	115	care organizations [as nonvoting members], all [one] of whom must
116	116	be physicians or pharmacists [a physician and one of whom must be a
117	117	pharmacist];
118	118	(3) include at least 17 physicians and pharmacists
119	119	who:
120	120	(A) provide services across the entire
121	121	population of Medicaid recipients and represent different
122	122	specialties, including at least one of each of the following types
123	123	of physicians:
124	124	(i) a pediatrician;
125	125	(ii) a primary care physician;
126	126	(iii) an obstetrician and gynecologist;
127	127	(iv) a child and adolescent psychiatrist;
128	128	and
129	129	(v) an adult psychiatrist; and
130	130	(B) have experience in either developing or
131	131	practicing under a preferred drug list; and
132	132	(4) include a consumer advocate who represents
133	133	Medicaid recipients.
134	134	(d) Notwithstanding any other law, members [Members]
135	135	appointed under Subsection (c)(2) may attend quarterly and other
136	136	regularly scheduled meetings, but may not:
137	137	(1) attend portions of the executive sessions in which
138	138	confidential drug pricing information is shared; or
139	139	(2) access confidential drug pricing information.
140	140	SECTION 6. If before implementing any provision of this Act
141	141	a state agency determines that a waiver or authorization from a
142	142	federal agency is necessary for implementation of that provision,
143	143	the agency affected by the provision shall request the waiver or
144	144	authorization and may delay implementing that provision until the
145	145	waiver or authorization is granted.
146	146	SECTION 7. This Act takes effect September 1, 2023.
147	147	______________________________ ______________________________
148	148	President of the Senate Speaker of the House
149	149	I certify that H.B. No. 3286 was passed by the House on May 5,
150	150	2023, by the following vote: Yeas 142, Nays 0, 1 present, not
151	151	voting; and that the House concurred in Senate amendments to H.B.
152	152	No. 3286 on May 25, 2023, by the following vote: Yeas 139, Nays 0,
153	153	1 present, not voting.
154	154	______________________________
155	155	Chief Clerk of the House
156	156	I certify that H.B. No. 3286 was passed by the Senate, with
157	157	amendments, on May 21, 2023, by the following vote: Yeas 31, Nays
158	158	0.
159	159	______________________________
160	160	Secretary of the Senate
161	161	APPROVED: __________________
162	162	Date
163	163	__________________
164	164	Governor