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AN ACT
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relating to the Medicaid Drug Utilization Review Program and |
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prescription drug use under the Medicaid program. |
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�������BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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�������SECTION�1.��Subchapter B, Chapter 531, Government Code, is |
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amended by adding Sections 531.0691, 531.0692, 531.0693, and |
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531.0694 to read as follows: |
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�������Sec.�531.0691.��MEDICAID DRUG UTILIZATION REVIEW PROGRAM: � |
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DRUG USE REVIEWS AND ANNUAL REPORT. (a) In this section: |
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�������������(1)��"Medicaid Drug Utilization Review Program"�means |
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the program operated by the vendor drug program to improve the |
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quality of pharmaceutical care under the Medicaid program. |
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�������������(2)��"Prospective drug use review" means the review of |
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a patient's drug therapy and prescription drug order or medication |
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order before dispensing or distributing a drug to the patient. |
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�������������(3)��"Retrospective drug use review" means the review |
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of prescription drug claims data to identify patterns of |
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prescribing. |
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�������(b)��The commission shall provide for an increase in the |
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number and types of retrospective drug use reviews performed each |
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year under the Medicaid Drug Utilization Review Program, in |
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comparison to the number and types of reviews performed in the state |
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fiscal year ending August 31, 2009. |
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�������(c)��In determining the number and types of drug use reviews |
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to be performed, the commission shall: |
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�������������(1)��allow for the repeat of retrospective drug use |
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reviews that address ongoing drug therapy problems and that, in |
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previous years, improved client outcomes and reduced Medicaid |
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spending; |
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�������������(2)��consider implementing disease-specific |
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retrospective drug use reviews that address ongoing drug therapy |
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problems in this state and that reduced Medicaid prescription drug |
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use expenditures in other states; and |
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�������������(3)��regularly examine Medicaid prescription drug |
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claims data to identify occurrences of potential drug therapy |
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problems that may be addressed by repeating successful |
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retrospective drug use reviews performed in this state and other |
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states. |
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�������(d)��In addition to any other information required by federal |
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law, the commission shall include the following information in the |
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annual report regarding the Medicaid Drug Utilization Review |
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Program: |
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�������������(1)��a detailed description of the program's |
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activities; and |
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�������������(2)��estimates of cost savings anticipated to result |
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from the program's performance of prospective and retrospective |
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drug use reviews. |
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�������(e)��The cost-saving estimates for prospective drug use |
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reviews under Subsection (d) must include savings attributed to |
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drug use reviews performed through the vendor drug program's |
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electronic claims processing system and clinical edits screened |
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through the prior authorization system implemented under Section |
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531.073. |
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�������(f)��The commission shall post the annual report regarding |
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the Medicaid Drug Utilization Review Program on the commission's |
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website. |
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�������Sec.�531.0692.��MEDICAID DRUG UTILIZATION REVIEW BOARD: |
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CONFLICTS OF INTEREST. �(a) A member of the board of the Medicaid |
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Drug Utilization Review Program may not have a contractual |
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relationship, ownership interest, or other conflict of interest |
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with a pharmaceutical manufacturer or labeler or with an entity |
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engaged by the commission to assist in the administration of the |
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Medicaid Drug Utilization Review Program. |
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�������(b)��The executive commissioner may implement this section |
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by adopting rules that identify prohibited relationships and |
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conflicts or requiring the board to develop a conflict-of-interest |
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policy that applies to the board. |
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�������Sec.�531.0693.��PRESCRIPTION DRUG USE AND EXPENDITURE |
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PATTERNS. (a) The commission shall monitor and analyze |
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prescription drug use and expenditure patterns in the Medicaid |
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program. �The commission shall identify the therapeutic |
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prescription drug classes and individual prescription drugs that |
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are most often prescribed to patients or that represent the |
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greatest expenditures. |
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�������(b)��The commission shall post the data determined by the |
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commission under Subsection (a) on the commission's website and |
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update the information on a quarterly basis. |
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�������Sec.�531.0694.��PERIOD OF VALIDITY FOR PRESCRIPTION. In its |
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rules and standards governing the vendor drug program, the |
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commission, to the extent allowed by federal law and laws |
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regulating the writing and dispensing of prescription medications, |
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shall ensure that a prescription written by an authorized health |
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care provider under the Medicaid program is valid for the lesser of |
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the period for which the prescription is written or one year. This |
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section does not apply to a prescription for a controlled |
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substance, as defined by Chapter 481, Health and Safety Code. |
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�������SECTION�2.��Section 531.071, Government Code, is amended by |
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amending Subsection (c) and adding Subsection (d) to read as |
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follows: |
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�������(c)��General information about the aggregate costs of |
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different classes of drugs is not confidential under Subsection |
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(a), except that a drug name or information that could reveal a drug |
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name is confidential. |
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�������(d)��Information about whether the commission and a |
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manufacturer or labeler reached or did not reach a supplemental |
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rebate agreement under Section 531.070 for a particular drug is not |
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confidential under Subsection (a). |
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�������SECTION�3.��Section 531.072, Government Code, is amended by |
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adding Subsections (b-1), (b-2), and (c-1) to read as follows: |
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�������(b-1)��Notwithstanding Subsection (b), the preferred drug |
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lists may contain: |
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�������������(1)��a drug provided by a manufacturer or labeler that |
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has not reached a supplemental rebate agreement with the commission |
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if the commission determines that inclusion of the drug on the |
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preferred drug lists will have no negative cost impact to the state; |
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or |
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�������������(2)��a drug provided by a manufacturer or labeler that |
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has reached an agreement with the commission to provide program |
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benefits in lieu of supplemental rebates, as described by Section |
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531.070. |
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�������(b-2)��Consideration must be given to including all |
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strengths and dosage forms of a drug on the preferred drug lists. |
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�������(c-1)��In addition to the considerations listed under |
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Subsection (c), the commission shall consider the inclusion of |
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multiple methods of delivery within each drug class, including |
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liquid, tablet, capsule, and orally disintegrating tablets. |
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�������SECTION�4.��Section 531.073, Government Code, is amended by |
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adding Subsections (g), (h), and (i) to read as follows: |
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�������(g)��The commission shall ensure that requests for prior |
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authorization may be submitted by telephone, facsimile, or |
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electronic communications through the Internet. |
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�������(h)��The commission shall provide an automated process that |
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may be used to assess a Medicaid recipient's medical and drug claim |
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history to determine whether the recipient's medical condition |
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satisfies the applicable criteria for dispensing a drug without an |
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additional prior authorization request. |
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�������(i)��The commission shall study the costs and benefits of the |
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prior authorization process and methods to improve efficiency. |
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�������SECTION�5.��Section 531.074, Government Code, is amended by |
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amending Subsections (i) and (m) and adding Subsections (f-1) and |
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(i-1) to read as follows: |
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�������(f-1)��The committee shall meet in public and shall permit |
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public comment before voting on any changes in the preferred drug |
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lists. Minutes of each meeting shall be made available to the |
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public not later than the 10th business day after the date the |
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minutes are approved. The committee may meet in executive session |
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to discuss confidential information as described by Subsection (i). |
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�������(i)��The commission shall adopt rules governing the |
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operation of the committee, including rules governing the |
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procedures used by the committee for providing notice of a meeting |
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and rules prohibiting the committee from discussing confidential |
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information described by Section 531.071 in a public meeting. The |
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committee shall comply with the rules adopted under this subsection |
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and Subsection (i-1). |
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�������(i-1)��In addition to the rules under Subsection (i), the |
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commission by rule shall require the committee or the committee's |
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designee to present a summary of any clinical efficacy and safety |
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information or analyses regarding a drug under consideration for a |
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preferred drug list that is provided to the committee by a private |
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entity that has contracted with the commission to provide the |
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information. The committee or the committee's designee shall |
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provide the summary in electronic form before the public meeting at |
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which consideration of the drug occurs. Confidential information |
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described by Section 531.071 must be omitted from the summary. The |
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summary must be posted on the commission's Internet website. |
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�������(m)��The commission or the commission's agent shall publicly |
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disclose, immediately after the committee deliberations conclude, |
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each specific drug recommended for or against preferred drug list |
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status for each drug class included in the preferred drug list for |
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the Medicaid vendor drug program. The disclosure must be posted on |
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the commission's Internet website not later than the 10th business |
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day [made in writing] after the conclusion of committee |
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deliberations that result in recommendations made to the executive |
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commissioner regarding the placement of drugs on the preferred drug |
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list. The public disclosure must include: |
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�������������(1)��the general basis for the recommendation for each |
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drug class; and |
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�������������(2)��for each recommendation, whether a supplemental |
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rebate agreement or a program benefit agreement was reached under |
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Section 531.070. |
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�������SECTION�6.��Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.0741 to read as follows: |
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�������Sec.�531.0741.��PUBLICATION OF INFORMATION REGARDING |
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COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT. The |
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commission shall publish on the commission's Internet website any |
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decisions on preferred drug list placement, including: |
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�������������(1)��a list of drugs reviewed and the commission's |
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decision for or against placement on a preferred drug list of each |
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drug reviewed; |
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�������������(2)��for each recommendation, whether a supplemental |
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rebate agreement or a program benefit agreement was reached under |
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Section 531.070; and |
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�������������(3)��the rationale for any departure from a |
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recommendation of the pharmaceutical and therapeutics committee |
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established under Section 531.074. |
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�������SECTION�7.��Not later than December 1, 2010, the executive |
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commissioner of the Health and Human Services Commission shall |
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implement Sections 531.073(g), (h), and (i), Government Code, as |
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added by this Act. |
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�������SECTION�8.��If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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�������SECTION�9.��This Act takes effect September 1, 2009. |
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______________________________ |
______________________________ |
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���President of the Senate |
Speaker of the House����� |
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�������I certify that H.B. No. 2030 was passed by the House on April |
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8, 2009, by the following vote:��Yeas 146, Nays 0, 1 present, not |
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voting; that the House refused to concur in Senate amendments to |
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H.B. No. 2030 on May 18, 2009, and requested the appointment of a |
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conference committee to consider the differences between the two |
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houses; and that the House adopted the conference committee report |
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on H.B. No. 2030 on May 27, 2009, by the following vote:��Yeas 142, |
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Nays 0, 1 present, not voting. |
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______________________________ |
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Chief Clerk of the House��� |
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�������I certify that H.B. No. 2030 was passed by the Senate, with |
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amendments, on May 12, 2009, by the following vote:��Yeas 31, Nays |
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0; at the request of the House, the Senate appointed a conference |
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committee to consider the differences between the two houses; and |
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that the Senate adopted the conference committee report on H.B. No. |
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2030 on May 30, 2009, by the following vote:��Yeas 31, Nays 0. |
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______________________________ |
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Secretary of the Senate��� |
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APPROVED: __________________ |
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����������������Date������� |
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�������� __________________ |
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��������������Governor������� |