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