HBA-MPM H.B. 1094 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 1094
By: Gray
Public Health
7/11/2001
Enrolled



BACKGROUND AND PURPOSE 

According to Families USA, the average cost per prescription for seniors
rose 48 percent in the past eight years.  A report released in 1999
revealed that the prices of the 50 prescription drugs most commonly used by
senior citizens rose faster than the rate of inflation for each of the
previous five years.  Seniors are most affected by these rising prices, as
those over age 65 are significantly more likely to be regular users of
prescription drugs.  Seniors are also less likely to be reimbursed for
prescription drug purchases, as Medicare does not provide prescription drug
coverage. One way for states to help seniors pay for prescription drugs is
to create a pharmaceutical assistance program. According to the National
Conference of State Legislatures, 26 states had authorized some type of
pharmaceutical assistance program as of February 2001.  House Bill 1094
establishes a state pharmaceutical assistance program similar to the
Medicaid vendor drug program to provide prescription drug benefits to
certain low-income Medicare recipients. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Health and Human Services
Commission in SECTION 1 (Section 531.302, Government Code) of this bill. 

ANALYSIS

House Bill 1094 amends the Government Code to require the Health and Human
Services Commission (HHSC) no later than January 1, 2002  to develop and
implement a state prescription drug program (program) that operates in the
same manner as the Medicaid vendor drug program.  The bill provides that a
person is eligible for program benefits if the person is a qualified
Medicare beneficiary (QMB), a specified low-income Medicare beneficiary
(SLMB) who is eligible for Medicare cost-sharing payments, a qualified
disabled and working individual (working disabled), and qualified
individuals (QI-1 and QI-2).  The bill specifies that the program may be
funded only with state money unless funds are available under federal law
to fund all or part of the program. 

The bill requires HHSC to adopt all rules necessary to implement the
program, and in doing so, HHSC is authorized to: 

_require a person eligible for prescription drug benefits to pay a
cost-sharing payment; 

_authorize the use of a prescription drug formulary to specify which
prescription drugs the program will cover; 

_to the extent possible, require clinically appropriate prior authorization
for prescription drug benefits in the same manner as it is required under
the Medicaid vendor drug program; and 

_establish a drug utilization review program to ensure the appropriate use
of prescription drugs under the program. 

 The bill requires HHSC in adopting rules for the program to consult with
an advisory panel of physicians, pharmacists, and pharmacologists appointed
by the commissioner of health and human services.  In adopting rules under
the state program, HHSC is authorized to require that a pharmacist may
select a generic equivalent of a prescribed drug unless the practitioner's
signature on a prescription clearly indicates that the prescription must be
dispensed as written.  If money available for the state program is
insufficient to provide prescription drug benefits to all eligible persons,
HHSC is required to limit the number of enrollees based on available
funding and to provide the benefits to eligible persons in the following
order of priority: 

_QMBs;

_SLMBs; and 

_the working disabled, QI-1 and QI-2s.

EFFECTIVE DATE

September 1, 2001.