87(R) HB 18 - Enrolled version - Bill Text

	H.B.  No.  18

	AN ACT
	relating to establishment of the prescription drug savings program
	for certain uninsured individuals.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION  1.    SHORT TITLE. This Act shall be known as "Texas
	Cares."
	SECTION  2.    PRESCRIPTION DRUG SAVINGS PROGRAM. Subtitle C,
	Title 2, Health and Safety Code, is amended by adding Chapter 65 to
	read as follows:
	CHAPTER 65. PRESCRIPTION DRUG SAVINGS PROGRAM FOR CERTAIN
	UNINSURED INDIVIDUALS
	SUBCHAPTER A. GENERAL PROVISIONS
	Sec.  65.001.    DEFINITIONS. In this chapter:
	(1)    "Enrollee" means an individual enrolled in the
	program.
	(2)    "Fund" means the trust fund established under
	Section 65.101.
	(3)    "Pharmacy benefit manager" has the meaning
	assigned by Section 4151.151, Insurance Code.
	(4)    "Prescription drug" has the meaning assigned by
	Section 551.003, Occupations Code.
	(5)    "Program" means the prescription drug savings
	program established under this chapter.
	(6)    "Uninsured individual" means an individual
	without health benefit plan coverage for a prescription drug
	benefit.
	Sec.  65.002.    CONSTRUCTION OF CHAPTER; PURPOSE. (a) This
	chapter does not establish an entitlement to assistance in
	obtaining benefits for uninsured individuals.
	(b)    The purpose of this chapter is to establish a program to
	provide uninsured individuals access to prescription drug benefits
	using money from the fund to pay an amount equal to the value of a
	prescription drug rebate at the point of sale and returning that
	rebate amount to the fund to ensure the amounts credited to the fund
	equal the amounts paid from the fund.
	(c)    This chapter does not expand the Medicaid program.
	Sec.  65.003.    RULES. The executive commissioner shall adopt
	rules as necessary to implement this chapter.
	SUBCHAPTER B. ESTABLISHMENT AND ADMINISTRATION OF PRESCRIPTION
	DRUG SAVINGS PROGRAM
	Sec.  65.051.    ESTABLISHMENT OF PROGRAM. (a) The commission
	shall develop and design a prescription drug savings program that
	partners with a pharmacy benefit manager to offer prescription
	drugs at a discounted rate to uninsured individuals.
	(b)    In developing and implementing the program, the
	commission shall ensure the program benefits do not include
	prescription drugs used for the elective termination of a
	pregnancy.
	(c)    The executive commissioner shall ensure the program is
	designed to provide the greatest possible value to uninsured
	individuals served by the program, while considering the adequacy
	of the prescription drug formulary, net costs of the drugs to
	enrollees, cost to the state, and other important factors
	determined by the commission.
	Sec.  65.052.    GENERAL POWERS AND DUTIES OF COMMISSION
	RELATED TO PROGRAM. (a) The commission shall oversee the
	implementation of the program and coordinate the activities of each
	state agency involved in that implementation.
	(b)    The commission shall design the program to be cost
	neutral by collecting prescription drug rebates after using money
	in the fund in amounts equal to the rebate amounts to purchase
	prescription drugs.
	(c)    The commission shall develop procedures for accepting
	applications for program enrollment, including a process to:
	(1)    determine eligibility, screening, and enrollment
	procedures that allow applicants to self attest to the extent
	authorized by federal law; and
	(2)    resolve disputes related to eligibility
	determinations.
	(d)    The commission shall publish on an Internet website all
	average consumer costs for each prescription drug available through
	the program.
	(e)    The commission and the contracted pharmacy benefit
	manager shall integrate manufacturer and other third-party patient
	assistance programs into the program to the extent feasible. A
	manufacturer or other third party may decline to link the
	manufacturer's or third party's patient assistance program to the