State Budget Including Medicaid Pharmacy Riders, SB 1

The Alliance was a strong advocate for important Medicaid reform measures, made possible by cost savings and program efficiencies in the Medicaid program as follows;

  • Rider 25 requires HHSC to continue to develop new delivery models for cost effectiveness and improved outcomes within the prescription drug benefit and other medical benefits, critical to initiating a comprehensive MTM program. 
  • Rider 34 requires HHSC look at copayments in the program, efficiencies in the administration of the prescription drug benefit, program flexibility with changes in federal funding, and greater scrutiny on MCO with audits every 2 years.
  • Rider 219 requires HHSC to study potential cost savings in the administration of prescription drug benefits, including a single statewide claims PBM model to deliver prescription drug benefits in the Medicaid, CHIP, Women's Health, Children with Special Health Care Needs Services, and Kidney Health Care programs. Also reduction of the Affordable Care Act Health Insurance Providers Fee, reducing MCO's guaranteed risk margin with prescriptions and administrative services fees from decreasing capitation related to pharmacy benefits. In addition the Rider will examine transitioning to a prescription pricing methodology based on National Average Drug Acquisition Cost with a professional dispensing fee commensurate with the most recent study commissioned by HHSC.

State Board of Pharmacy

HB 2561 continues the Texas State Board of Pharmacy making significant changes to the role and responsibilities of pharmacists and technicians in the profession.

  • Establishes requirements of prescribers and pharmacists with the state "Prescription Drug Monitoring Program" who prescribe and dispense controlled substances. The requirements are effective September 2019 for monitoring of patients prescribed and dispensed hydrocodone, benzodiazepines, barbiturates, and cariosoprodol. 
    • Creates a "joint interim committee" to study and make recommendations on access to technology, readiness, costs, and the role of veterinarians in monitoring human access to controlled substances for their pets 
    • Veterinarians are currently exempt from the 2019 requirements 
    • Creates exceptions to the mandatory PMP look up for patients with cancer or receiving hospice care 
    • Creates a "remote pharmacy" designation for dispensing pharmacy sites, managed by pharmacy technicians in rural communities tied to a "host" Class A pharmacy via audio and video connection.
    • Authorizes limited instances where a pharmacy may dispense returned/donated prescription drugs
    • Authorizes the remote supervision of pharmacy technicians
    • Requires a pharmacy technician to comply with the continuing education requirements prescribed by the Board upon renewal

Drug Synchronization

HB 1296 provides requirements that health benefit plans implement processes for access and payment for prescription drug synchronization. This legislation allows patients with multiple medications for chronic conditions to align their prescription drug dispensing on the same day of the month.

Step Therapy Patient Protections and Restrictions on PBMs and MCOs

The Alliance strongly supported SB 680, creating patient protections using clinically based criteria for determining prescription drug effectiveness and prior authorization criteria. SB 680 requires health plans to establish, implement, and administer the step therapy protocol in accordance with medical and clinical review criteria. The bill requires clinical practice guidelines that are developed and endorsed by a multidisciplinary panel of experts, based on high quality studies, research, and medical practice as the basis for determining prior authorization criteria and decision making in arbitrary formulary changes.

Defensive Legislation that Didn't Pass

  • Doctor dispensing
  • Workers' Compensation Benefits that restrict compounded prescription drugs

Six pieces of legislation that require additional work. 
1. NADAC reference pricing reimbursement 
2. Vaccine and immunizations expansion for pharmacy
3. Patient Access to Pharmacists Act
4. Required E-prescribing of controlled substances.
5. Cost saving or rate transparency of MCOs in Medicaid
6. Administrative review of "reasonable" dispensing fee

The Alliance appreciates the efforts of the other pharmacy advocacy groups for passing and defending off legislation important to our profession this Session.