82R3938 PMO-D     By: Lozano H.B. No. 762       A BILL TO BE ENTITLED   AN ACT   relating to establishing a pill splitting program to reduce health   plan costs for certain public employees.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter E, Chapter 1551, Insurance Code, is   amended by adding Section 1551.226 to read as follows:          Sec. 1551.226.  ESTABLISHMENT OF PILL SPLITTING PROGRAM.     (a)  In this section:                (1)  "Eligible prescription pill" means a prescription   medication delivered in pill form that is appropriate for   splitting, as determined under Subsection (c), and is listed on the   applicable drug formulary, if any, described by Section 1551.218.                (2)  "Manufacturer" has the meaning assigned by Section   431.401, Health and Safety Code.                (3)  "Pill splitting" means dividing an eligible   prescription pill to obtain a prescribed dose.          (b)  The board of trustees by rule shall design and establish   a voluntary pill splitting program. The pill splitting program   must:                (1)  include a copayment reduction incentive for   individuals covered by the group benefits program who participate   in the pill splitting program; and                (2)  require an individual who participates in the pill   splitting program to:                      (A)  obtain a prescription for an eligible   prescription pill authorizing pill splitting from the prescribing   physician before participating; and                      (B)  personally split the eligible prescription   pill.          (c)  As directed by the committee established under Section   554.0055, Occupations Code, the board of trustees shall:                (1)  adopt the list of eligible prescription pills as   established and updated by the committee; and                (2)  make the list of eligible prescription pills and   educational materials developed under Section 554.0055,   Occupations Code, available to all persons covered by a health   benefit plan under the group benefits program.          (d)  A manufacturer is not subject to criminal prosecution or   liable for damages in a civil action for an injury, death, or loss   to a person or of property arising out of the program established   under this section. This section may not be construed to create or   affect a cause of action against a manufacturer.          (e)  The board of trustees shall report at least annually to   the Legislative Budget Board and the governor on the design of the   pill splitting program, the medications included on the list of   eligible prescription pills, participation in the program, and cost   savings resulting from the program.          SECTION 2.  Subchapter D, Chapter 1575, Insurance Code, is   amended by adding Section 1575.171 to read as follows:          Sec. 1575.171.  ESTABLISHMENT OF PILL SPLITTING PROGRAM.   (a)  In this section:                (1)  "Eligible prescription pill" means a prescription   medication delivered in pill form that is appropriate for   splitting, as determined under Subsection (c), and is listed on the   applicable drug formulary, if any, described by Section 1575.170.                (2)  "Manufacturer" has the meaning assigned by Section   431.401, Health and Safety Code.                (3)  "Pill splitting" means dividing an eligible   prescription pill to obtain a prescribed dose.          (b)  The trustee by rule shall design and establish a   voluntary pill splitting program. The pill splitting program must:                (1)  include a copayment reduction incentive for   individuals covered by the group program who participate in the   pill splitting program; and                (2)  require an individual who participates in the pill   splitting program to:                      (A)  obtain a prescription for an eligible   prescription pill authorizing pill splitting from the prescribing   physician before participating; and                      (B)  personally split the eligible prescription   pill.          (c)  As directed by the committee established under Section   554.0055, Occupations Code, the trustee shall:                (1)  adopt the list of eligible prescription pills as   established and updated by the committee; and                (2)  make the list of eligible prescription pills and   educational materials developed under Section 554.0055,   Occupations Code, available to all persons covered by a health   benefit plan under the group program.          (d)  A manufacturer is not subject to criminal prosecution or   liable for damages in a civil action for an injury, death, or loss   to a person or of property arising out of the program established   under this section. This section may not be construed to create or   affect a cause of action against a manufacturer.          (e)  The trustee shall report at least annually to the   Legislative Budget Board and the governor on the design of the pill   splitting program, medications included on the list of eligible   prescription pills, participation in the program, and cost savings   resulting from the program.          SECTION 3.  Subchapter C, Chapter 1579, Insurance Code, is   amended by adding Section 1579.109 to read as follows:          Sec. 1579.109.  ESTABLISHMENT OF PILL SPLITTING PROGRAM.     (a)  In this section:                (1)  "Eligible prescription pill" means a prescription   medication delivered in pill form that is appropriate for   splitting, as determined under Subsection (c), and is listed on the   applicable drug formulary, if any, described by Section 1579.106.                (2)  "Manufacturer" has the meaning assigned by Section   431.401, Health and Safety Code.                (3)  "Pill splitting" means dividing an eligible   prescription pill to obtain a prescribed dose.          (b)  The trustee by rule shall design and establish a   voluntary pill splitting program. The pill splitting program must:                (1)  include a copayment reduction incentive for   individuals covered by a health coverage plan under this subchapter   who participate in the pill splitting program; and                (2)  require an individual who participates in the pill   splitting program to:                      (A)  obtain a prescription for an eligible   prescription pill authorizing pill splitting from the prescribing   physician before participating; and                      (B)  personally split the eligible prescription   pill.          (c)  As directed by the committee established under Section   554.0055, Occupations Code, the trustee shall:                (1)  adopt the list of eligible prescription pills as   established and updated by the committee; and                (2)  make the list of eligible prescription pills and   educational materials developed under Section 554.0055,   Occupations Code, available to all persons covered by a health   coverage plan under the uniform group coverage program.          (d)  A manufacturer is not subject to criminal prosecution or   liable for damages in a civil action for an injury, death, or loss   to a person or of property arising out of the program established   under this section. This section may not be construed to create or   affect a cause of action against a manufacturer.          (e)  The trustee shall report at least annually to the   Legislative Budget Board and the governor on the design of the pill   splitting program, medications included in the list of eligible   prescription pills, participation in the program, and cost savings   resulting from the program.          SECTION 4.  Subchapter C, Chapter 1601, Insurance Code, is   amended by adding Section 1601.111 to read as follows:          Sec. 1601.111.  ESTABLISHMENT OF PILL SPLITTING PROGRAM.     (a)  In this section:                (1)  "Eligible prescription pill" means a prescription   medication delivered in pill form that is appropriate for   splitting, as determined under Subsection (c), and is listed on the   applicable drug formulary, if any, established for group health   benefit coverage under a uniform program.                (2)  "Manufacturer" has the meaning assigned by Section   431.401, Health and Safety Code.                (3)  "Pill splitting" means dividing an eligible   prescription pill to obtain a prescribed dose.          (b)  Each system by rule shall design and establish a   voluntary pill splitting program. The pill splitting program must:                (1)  include a copayment reduction incentive for   individuals covered by a health benefit plan provided under this   chapter who participate in the program; and                (2)  require an individual who participates in the   program to:                      (A)  obtain a prescription for an eligible   prescription pill authorizing pill splitting from the prescribing   physician before participating; and                      (B)  personally split the eligible prescription   pill.          (c)  As directed by the committee established under Section   554.0055, Occupations Code, a system shall:                (1)  adopt the list of eligible prescription pills as   established and updated by the committee; and                (2)  make the list of eligible prescription pills and   educational materials developed under Section 554.0055,   Occupations Code, available to all persons covered by a health   benefit plan under a uniform program.          (d)  A manufacturer is not subject to criminal prosecution or   liable for damages in a civil action for an injury, death, or loss   to a person or of property arising out of the program established   under this section. This section may not be construed to create or   affect a cause of action against a manufacturer.          (e)  Each system shall report at least annually to the   Legislative Budget Board and the governor on the design of the pill   splitting program, medications included in the list of eligible   prescription pills, participation in the program, and cost savings   resulting from the program.          SECTION 5.  Subchapter A, Chapter 554, Occupations Code, is   amended by adding Section 554.0055 to read as follows:          Sec. 554.0055.  PILL SPLITTING COMMITTEE. (a)  The board   shall establish a committee to prepare and periodically update for   purposes of Sections 1551.226, 1575.171, 1579.109, and 1601.111,   Insurance Code, a list of prescription pills that are appropriate   for splitting and would not be chemically destabilized or rendered   therapeutically ineffective if split.          (b)  The committee shall consist of:                (1)  a pharmacist member of the board who serves as   presiding officer of the committee;                (2)  two community pharmacists;                (3)  two health system pharmacists; and                (4)  two physicians.          (c)  The committee shall develop and make available for   distribution to program participants under Chapter 1551, 1575,   1579, or 1601, Insurance Code, educational materials that must   include:                (1)  plain-language instruction about safely and   effectively splitting an eligible prescription pill; and                (2)  information about:                      (A)  pills that are eligible for splitting;                      (B)  characteristics of an individual suited to   participate in a pill splitting program; and                      (C)  ways to enroll and participate in a pill   splitting program.          SECTION 6.  The initial reports required by Sections   1551.226(e), 1575.171(e), 1579.109(e), and 1601.111(e), Insurance   Code, as added by this Act, are due not later than September 1,   2013.          SECTION 7.  The changes in law made by this Act apply only to   health benefit plans provided under Chapters 1551, 1575, 1579, and   1601, Insurance Code, beginning with the 2011-2012 plan year. A   plan year before 2011-2012 is governed by the law as it existed   immediately before September 1, 2011, and that law is continued in   effect for that purpose.          SECTION 8.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution.  If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2011.