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2019 Texas Legislative Wrap-up
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86th Texas Legislative Session Wrapup-Pharmacy

 

Pharmacy Advocacy Wins Include Payment for Services, Collaborative Practice, Provider Recognition, E-Prescribing of Controlled Substances, and Wholesale Audit Protections

Pharmacy Day at the Capitol 2019

JUMP TO:  Session in Brief  |  Notable Bills Passed Affecting Pharmacy  |  Pharmacy Losses  |  Pharmacy Defensive Victories  |  Other Passed Bills of Interest

 

Pharmacy emerged from the 2019 Texas legislative session with some notable wins, some disappointing losses, and successful defensive victories. The Texas Pharmacy Association’s voice was vital throughout the biennial session, which began January 8 and ended May 27. TPA took a leadership role this session beginning in October 2017, bringing eight Texas pharmacy organizations together as the Texas Pharmacy Summit to meet monthly to determine pharmacy’s legislative priorities. TPA continued leading the way during the session by coordinating weekly meetings of the Pharmacy Advisory Group, comprising the lobbyists representing any pharmacy interest in Texas.

TPA spearheaded and organized Pharmacy Day at the Capitol on February 26, where nearly 600 pharmacists, pharmacy technicians, and student pharmacists participated in a powerful lobby day. TPA’s legislative presence was felt at the Capitol as dozens of pharmacists returned to Austin during the session to visit with legislators and their staffs, testify before House and Senate committees, and lobby for legislation designed to elevate the profession, advance the practice, and protect the business of pharmacy. Thanks to our many member advocates and Association supporters, we achieved several of our top legislative priorities while amplifying our voice at the State Capitol.

Working together, pharmacy zeroed in on about 10 business and professional issues as its collective focus. TPA took the lead on three of these issues—payment for services, collaborative practice, and enhanced pharmacist services—and TPA is proud that two of them passed! As the only Texas pharmacy organization that represents all pharmacy professionals, regardless of practice setting, TPA was extremely active and supported all pharmacy legislation that was good for the profession.

TPA greatly appreciates the support of our lone pharmacist legislator, Senator Charles Schwertner, as well as the hard work from many pro-pharmacy state Senators and state Representatives, all of whom stood up for pharmacists and fought for pharmacy priorities during the 2019 legislative session. We look forward to strengthening these relationships during the interim and working together again during the 2021 session.

 


The Session in Brief

Texas State CapitolWhen the 86th legislative session gaveled in and Governor Greg Abbott gave his biennial State of the State address, the focus was on meat-and-potatoes policy reforms. Abbott, Lieutenant Governor Dan Patrick and newly minted House Speaker Dennis Bonnen outlined school finance reform, teacher pay raises and property tax relief as their consensus items. The theme at the start of the session was that everyone was going to work together collaboratively with a focus and commitment on these emergency items. They promised a serious, no-nonsense legislative session—and for the most part, that’s what the “Big Three” elected officials delivered.

Legislators filed 7,067 bills, 1,427 of which passed (968 House bills and 459 Senate bills), and 10 Constitutional amendments will be decided by voters in November. It is a lot easier to kill a bill than it is to pass one!

At a press conference four days before it all ended, the Big Three declared legislative victory for the people of Texas. The Legislature had reached agreements on its top three priorities: a two-year state balanced budget, a comprehensive reform of school finance, and legislation designed to slow the growth of rising property taxes. And, in the process, the Legislature passed some notable bills that affect pharmacy. The Governor has until June 16 to take action on the bills.

 


Notable Bills Passed Affecting Pharmacy

Pharmacy scored some key wins this session with bills that recognize all pharmacists in team-based care with collaborative practice clarification and that allow for payment for services as well as recognition of pharmacists as a healthcare practitioners. TPA also supported other legislation that is positive for the profession. Still other bills were passed that affect pharmacists and pharmacies.

 

Collaborative Practice Clarification: PHARMACY WIN!

Senate Bill 1056 (Sen. Zaffirini/Rep. Raney)

SB 1056 amends the Occupations Code and clarifies that a physician may delegate to any properly qualified and trained pharmacist the implementation and modification of a patient’s drug therapy under protocol.

What does this mean for pharmacists?

Pharmacists, particularly those practicing in a community or long-term care setting, can now be part of team-based care through collaborative practice. All pharmacists may now enter into collaborative practice agreements with physicians for their patients and establish protocols to make changes to a patient’s drug therapy regimen.

Effective Date: Not later than December 1, 2019, the Texas State Board of Pharmacy shall adopt rules to implement [signed into law by Governor Abbott]

 

Payment for Services/Payment Parity: PHARMACY WIN!

House Bill 3441 (Rep. Lucio III/Sen. Schwertner)

HB 3441 amends the Insurance Code for commercial health plans in Texas. It prohibits a health benefit plan issuer or pharmacy benefit manager of a health benefit plan from denying reimbursement to a pharmacist for the provision of a service or procedure within the scope of the pharmacist’s license that would be covered by the insurance policy or other coverage agreement if the service or procedure were provided by a physician, an advanced practice nurse, or a physician assistant.

What does this mean for pharmacists?

Pharmacists may now be part of provider networks and be reimbursed for pharmacist-provided services that are within the pharmacist’s scope of practice. Types of services that may be covered include: medication management; administering CLIA-waived tests like those for flu, cholesterol, and blood glucose testing; chronic disease management, like diabetes self-management; and other patient education programs.

Effective Date: For health benefit plans issued or renewed on or after January 1, 2020 [signed into law by Governor Abbott]

 

Pharmacists Recognized as a Practitioner: PHARMACY WIN!

House Bill 1757 (Rep. Lucio III/Sen. Schwertner)

HB 1757 amends the Insurance Code for commercial health plans in Texas. It adds pharmacists to the list of health care practitioners and allows an insured beneficiary to select a pharmacist to provide the services in the health insurance policy that are within the pharmacist’s scope of practice.

What does this mean for pharmacists?

Pharmacists may now be in provider networks and be reimbursed for services that are within their scope of practice. By being listed as a practitioner, an insurer may not discriminate against pharmacists for payment or reimbursement for services performed in the scope of that pharmacist’s license if the same services or procedures are provided and covered by another listed health care practitioner.

Effective Date: For health benefit plans issued or renewed on or after January 1, 2020 [signed into law by Governor Abbott]

 

Pharmacist Prescription Signature Authority under Collaborative Practice: PHARMACY WIN!

House Bill 2425 (Rep. Kacal/Sen. Schwertner)

HB 2425 amends the Occupations Code and allows a physician to delegate to a pharmacist practicing in a federally qualified health center (FQHC) the implementation or modification of a patient’s drug therapy under protocol, including the authority to sign a prescription drug order for dangerous drugs.

What does this mean for pharmacists?

Pharmacists working in an FQHC are now allowed to adjust and manage a patient’s drug therapy, including the signing of the prescription drug order, with a physician’s delegation. This practice is already allowed in hospitals, hospital-based clinics, and academic health care institutions. This will allow patients in medically underserved areas to receive expanded access to care and for pharmacists in those areas to provide more services.

Effective Date: September 1, 2019 [signed into law by Governor Abbott]

 

Pharmacy Protection from Wholesale Invoice Audits: PHARMACY WIN!

House Bill 1455 (Rep. Hunter/Sen. Buckingham)

HB 1455 prohibits pharmacy benefit managers (PBMs) that audit wholesale invoices from auditing claims that a pharmacy has from another PBM or health plan. PBMs are prohibited from finding an audit discrepancy if the National Drug Code (NDC) for the dispensed drug is in a quantity that is a subunit or multiple of the drug purchased by the pharmacist or pharmacy as supported by a wholesale invoice, the pharmacist or pharmacy dispensed the correct quantity of the drug according to the prescription, and the drug dispensed by the pharmacist or pharmacy shares all but the last two digits of the NDC of the drug reflected on the supplier invoice. Additionally, PBMs are required to accept the copies of supplier invoices possessed by the audited pharmacy as evidence to support the validity of a claim, subject to the validation by pharmacy purchase order and payment of supplier invoice.

What does this mean for pharmacists?

Community pharmacies in Texas are now protected from overreach by PBM practices in wholesale invoice audits that attempt to unnecessarily penalize businesses for legitimate claims based on administrative technicalities. Pharmacies may now avoid said penalties that could be a financial burden.

Effective Date: September 1, 2019 [signed into law by Governor Abbott]

 

Mandatory e-Prescribing of Controlled Substances: PHARMACY WIN!

House Bill 2174 (Rep. Zerwas/Sen. Kolkhorst)

HB 2174 requires the electronic prescribing of all controlled substances (CII–CV) beginning January 1, 2021. The law provides for prescriber waivers, which may be renewed annually, if there is economic hardship, technological limitations not reasonably within the control of the prescriber, or other exceptional circumstances demonstrated by the prescriber. The law also provides for exceptions when a controlled substance is not required to be prescribed electronically, including issuance by a veterinarian; when electronic prescribing is not available due to temporary technological or electronic failure, as prescribed by board rule; and when necessary elements are not supported by the most recently implemented national data standard that facilitates electronic prescribing (which may be the case with compounded prescriptions today). A pharmacist who receives a controlled substance prescription in a manner other than electronically is not required to verify that the prescription is exempt from the requirement of electronic submission. The pharmacist may dispense a controlled substance pursuant to an otherwise valid written, oral, or telephonically communicated prescription. The Texas State Board of Pharmacy and regulatory entities for prescribers will jointly develop rules to implement the law, and each regulatory entity will enforce the law and issue waivers for the agency’s licensees.

This bill also requires that, beginning September 1, 2019, for the treatment of acute (not chronic) pain, a practitioner may not issue a prescription for an opioid in an amount that exceeds a 10-day supply, nor provide for a refill of an opioid for acute pain. Exceptions are provided for cancer care, hospice or other end-of-life care, palliative care, and opioids prescribed for the treatment of substance addiction.

In addition, this bill requires two hours of continuing education for pharmacists regarding the monitoring of controlled substances.

What does this mean for pharmacists?

Community pharmacists will especially benefit from the documentation, accuracy and accountability of electronic prescribing of controlled substances, which will improve patient care. It also increases safety and security in the prescribing process. Not only does it eliminate handwriting errors, the Drug Enforcement Administration’s (DEA) e-prescribing requirements call for two-factor authentication, reducing the likelihood of fraudulent prescribing. Additional benefits include workflow improvement through decreased phone calls and adherence improvement by allowing providers to monitor and improve first-fill adherence, as patients are more likely to fill prescriptions that are sent electronically to their pharmacy.

Effective Date: January 1, 2021 for e-prescribing of controlled substances; September 1, 2019 for acute pain opioid prescription quantity limits; September 1, 2021 for continuing education requirement [signed into law by Governor Abbott]

 

Prescribing and Dispensing of Controlled Substances/Prescription Monitoring Program Delay

House Bill 3284 (Rep. Sheffield/Sen. Nelson)

HB 3284 delays until March 1, 2020 the requirement for pharmacists and prescribers to check the Prescription Monitoring Program (PMP) history before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The bill also establishes an advisory committee of five physicians, three pharmacists (one chain, one independent, one academic), an oral surgeon, a physician assistant or nurse practitioner, and two health information technology individuals to serve three-year terms and meet at least twice yearly. The advisory committee will make recommendations to the Texas State Board of Pharmacy regarding operational improvements to the PMP, resolutions to identified data concerns, methods to improve data accuracy, integrity, and security, and reducing technical difficulties.

What does this mean for pharmacists?

Pharmacists and prescribers are provided a six-month delay of the mandatory check of the PMP to allow time for the integration of the PMP NarxCare tool. NarxCare helps prescribers and pharmacists analyze real-time controlled substance data and provides patient risk scores. This is to help identify potential risk factors by which pharmacists’ and prescribers’ can make decisions on potential drug misuse or abuse, ultimately leading to improved patient safety. Pharmacists and prescribers are required to check the PMP to help eliminate duplicate and overprescribing of controlled substances, as well as to obtain critical controlled substance history information.

Effective Date: March 1, 2020 for checking the PMP; September 1, 2019 for advisory committee

 

Safe Disposal of Schedule II Controlled Substances

House Bill 2088 (Rep. Dean/Sen. Hughes)

HB 2088 requires that a pharmacist who dispenses Schedule II controlled substances must provide written notice on the safe disposal of controlled substances unless the dispensing pharmacy is authorized to take back those drugs for disposal, regularly accepts those drugs for safe disposal, or provides at no cost to the patient either a mail-in pouch to dispose of the drugs or chemicals to render the unused drugs unusable. The Texas State Board of Pharmacy will adopt rules with details for the written notice that must include information on the locations where the Schedule II controlled substance prescription drugs are accepted for safe disposal or an internet address that helps locate these disposal locations.

What does this mean for pharmacists?

In an effort to address the opioid epidemic and properly dispose of harmful opioid medications to keep them out of reach, pharmacists who dispense Schedule II controlled substances that do not have a way for patients to return or dispose of these medications must provide a written notice of where the medications may be disposed.

Effective Date: January 1, 2020

 

Pharmacy Financial Disclose and Surety Bond Requirements

House Bill 3496 (Rep. Sheffield/Sen. Creighton)

HB 3496 requires applicants who apply for a pharmacy license to disclose financial information on pharmacy ownership. With the exception of a pharmacy that is operated by a publicly traded company, a pharmacy that is wholly owned by a retail grocery store chain, or a pharmacy applying for a Class B or Class C license, the applicant for a pharmacy license is required to provide the name of each person who has a direct financial investment in the pharmacy, the name of each person who is not an individual or has any financial investment in the pharmacy, and the total amount or percentage of the financial investment made by each person. A surety bond up to $25,000 may be required by pharmacies who are investigated for no longer engaging in the business for which they obtain a pharmacy license; engaging in fraud, deceit, or misrepresentation; or dispensing drugs for nontherapeutic purposes. The Texas State Board of Pharmacy is given authority to revoke the pharmacy license of a pharmacy that has ceased to operate for a period of 30 days or longer.

What does this mean for pharmacists?

This bill pertains to financial disclosure by independent pharmacies and updates the Texas State Board of Pharmacy application process and oversight of pharmacies in Texas to deter fraudulent operations. Applicable pharmacies applying for a license will now be required to disclose ownership information. Pharmacies investigated for engaging in improper activity may be required to pay up to a $25,000 surety bond.

Effective Date: January 1, 2020

 

Initiatives to Identify, Prevent, and Respond to Opioid Addiction, Misuse, and Abuse

House Bill 3285 (Rep. Sheffield/Sen. Huffman)

HB 3285 requires a prescriber or pharmacist whose practice includes the prescribing or dispensing of opioids to annually receive at least one hour of continuing education covering best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments. The Texas State Board of Pharmacy will adopt rules for pharmacists to establish the content of continuing education (CE) described by this subsection. This CE requirement expires August 31, 2023. The Texas State Board of Pharmacy is also required to encourage pharmacists to participate in a program that provides a comprehensive approach to the delivery of early intervention and treatment services for persons with substance use disorders and persons who are at risk of developing substance use disorders, such as a program promoted by the Substance Abuse and Mental Health Services Administration within the United States Department of Health and Human Services. This bill also develops a statewide opioid misuse public awareness campaign established by the Health and Human Services Commissioner to deliver public service announcements that explain and clarify certain risks related to opioid misuse including the risk of overdose, addiction, respiratory depression, or over-sedation, as well as risks involved in mixing opioids with alcohol or other medications.

What does this mean for pharmacists?

Pharmacists who dispense opioids are required to have at least one hour of continuing education covering alternative or multi-modal treatment approaches to pain management. Pharmacists will also be looked to and encouraged to participate in early intervention and treatment services for persons with substance use disorders and for those at risk of developing these disorders.

Effective Date: September 1, 2019; opioid awareness campaign not later than December 1, 2019

 

Texas State Board of Pharmacy Cleanup Bill

SB 683 (Sen. Buckingham/Rep. Allison) & HB 2847 (Rep. Goldman/Sen. Hancock)

SB 683 and HB 2847 update sections of the Texas Pharmacy Act and the Controlled Substance Act. These bills require pharmacies to submit a “zero” report if the pharmacy does not dispense any controlled substances during a seven-day period; authorize pharmacist interns to have access to the Prescription Monitoring Program (PMP) and authorize pharmacy technician trainees to have access to the PMP as a delegate; require wholesale distributors to report all controlled substances to the Board in the same manner as reported to the DEA; allow the PMP workgroup to meet when necessary as determined by the Board; allow Class E pharmacies to be processing facilities or perform another pharmaceutical service as defined by board rule; repeal Canadian Pharmacy provisions to not be in violation of federal law; and repeal the section that prevents the license renewal of a pharmacy in Texas if a pharmacy owned by the same company is subject to disciplinary action in another state. SB 683 also gives the Texas State Board of Pharmacy the authority to revoke the pharmacy license of a pharmacy that has ceased to operate for a period of 30 days or longer.

What does this mean for pharmacists?

With these “cleanup” measures, pharmacists are not confused by inconsistencies in language and conflicting provisions.

Effective Date: September 1, 2019 [signed into law by Governor Abbott]

 

Communication Regarding Biological Products

House Bill 1264 (Rep. S. Thompson/Sen. Buckingham)

HB 1264 repeals the September 1, 2019 sunsetting of the law requiring pharmacists to communicate to the prescribing practitioner the specific biological product provided to the patient. Current law will continue to be followed after September 1, 2019.

What does this mean for pharmacists?

There is no change to the current process pharmacists use with regard to communicating dispensing of biological products.

Effective Date: Immediate upon Governor’s approval on May 7, 2019 [signed into law by Governor Abbott]

 

Sale of Dextromethorphan to Minors

House Bill 1518 (Rep. Coleman/Sen. Seliger)

HB 1518 prohibits the sale of dextromethorphan “over the counter” to individuals under the age of 18 years. Before dispensing, distributing or selling dextromethorphan over the counter, a business establishment must require a driver’s license or other form of identification containing the customer’s photograph and age. If their outward appearance allows for reasonable presumption that the customer is greater than 27 years of age identification is not required to be requested. If there is a prescription for the medication, it is legal for a pharmacist to dispense for valid medical purpose to someone less than 18 years of age.

What does this mean for pharmacists?

Community pharmacies and store owners should be diligent programing any systems and educating their staff of this new law to avoid liability and civil penalties, while protecting minors from abuse of dextromethorphan. Pharmacists may dispense dextromethorphan with a valid prescription to someone less than 18 years of age.

Effective Date: September 1, 2019 [signed into law by Governor Abbott]

 

Telepharmacy Expansion to FQHCs

Senate Bill 670 (Sen. Buckingham/Rep. Oliverson)

SB 670 allows for a telepharmacy to be located at a federally qualified health center (FQHC) and in a community in which a Class A or Class C pharmacy is located. The bill leaves in place all operational requirements for telepharmacies, including the requirement that one pharmacy license holder may operate no more than two telepharmacies, and maintains prescription volume limits.

What does this mean for pharmacists?

Pharmacy owners now have the opportunity to partner with FQHCs to open telepharmacy locations in their facilities.

Effective Date: September 1, 2019

 

2020–21 State Budget

HB 1 (Rep. Zerwas/Sen. Nelson)

HB 1 is the 2020–21 state budget and has a price tag of $250.7 billion. The two-year budget includes $84 billion for health and human services programs. HB 1 orders roughly $900 million in cuts to Medicaid, the federal-state health insurance program for the poor and disabled that makes up most of the state’s health care spending. The Texas Health and Human Services Commission will be responsible for identifying cost-cutting measures.

What does this mean for pharmacists?

Pharmacy will have to stay diligent and stave off any cuts to pharmacy. By the same token, there is opportunity to make the case to pay pharmacists for cost-effective services they can provide.

Effective Date: September 1, 2019

 

Supplemental Budget

SB 500 (Sen. Nelson/Rep. Zerwas)

SB 500 is the supplemental budget and includes $6,099,000 for the Prescription Monitoring Program. The Texas State Board of Pharmacy does not need to spend all of the money by the end of this fiscal year, but must obligate all funds by June of 2021 to be able to spend it through August of 2021.

What does this mean for pharmacists?

The Texas State Board of Pharmacy has the funding and will integrate NarxCare into the Prescription Monitoring Program. NarxCare will help pharmacists analyze real-time controlled substance data and provides patient risk scores to help identify potential risk factors by which pharmacists can make decisions on potential drug misuse or abuse, ultimately leading to improved patient safety.

Effective Date: Immediate upon Governor’s approval [signed into law by Governor Abbott]


Pharmacy Losses

The strength of the PBMs, health plans, and physicians in Texas derailed pharmacy’s top legislative priorities dealing with business issues and practice advancement. It was evident this session that pharmacy needs to be more unified and more financially viable in the political arena.

 

Pharmacy Benefit Manager (PBM) Reform

House Bill 2817 (Rep. Lucio III/Sen. Hughes) & House Bill 2231 (Rep. Oliverson/Sen. Kolkhorst)

HB 2817, including provisions from HB 2231 (Rep. Oliverson), would have required transparency in contracting by PBMs; prohibited post-adjudication, reduction of payments or recoupment of claims, including DIR or GER-like fees; prohibited PBMs from paying PBM-affiliated pharmacies more than they pay other pharmacies in a network; allowed access to contract provisions; provided legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals or complaints against PBMs; prohibited PBMs from including contract language that prohibits pharmacies from delivering or mailing prescriptions to patients; and prevented PBMs from requiring pharmacies to obtain additional accreditations and certifications beyond what is required by the Texas State Board of Pharmacy.

 

Pharmacy Medicaid Reform

House Bill 3388 (Rep. Sheffield/Sen. Kolkhorst)

HB 3388 would have required PBMs in Medicaid managed care to establish a reimbursement floor for pharmacies, which would have paid pharmacies the Medicaid fee-for-service rate of the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee.

Pharmacy Protection from Network Termination

House Bill 1905 (Rep. Klick/Sen. Perry)

HB 1905 would have required the insurer to provide a reason for network termination and protected the rights of a pharmacist by allowing for an expedited review.

 

Enhanced Pharmacy Services: Allow Pharmacists to “Test and Treat” and Furnish Non-Diagnostic Medications

SB 835/HB 4285 (Sen. Miles/Rep. Zedler)

SB 835/HB 4285 would have allowed pharmacists under physician protocol to furnish tobacco cessation medication, self-administered hormonal contraception, travel medication, prenatal vitamins, and vitamin D in addition to furnishing antiviral and antibiotics for a positive CLIA-waived test for flu and strep throat, respectively. After seeing scope of practice bills locked up in a subcommittee, TPA saw an opportunity and pivoted its strategy on HB 4285 to have the bill heard in the House Public Health Committee. The new bill language would have allowed pharmacists under physician protocol to furnish antiviral medications after hours and on weekends to persons 18 years and older with a positive CLIA-waived test for influenza, which would have allowed pharmacists to “test and treat” for flu and increased access to care, lowered costs and improved health outcomes.

 

Enhanced Pharmacy Services: Allow Pharmacists to “Test and Treat”

HB 1827 (Rep. Howard)

HB 1827 would have allowed pharmacists under physician protocol to furnish antiviral and antibiotics for a positive CLIA-waived test for flu and strep throat.

 

Expanding Access to Immunizations for School-Aged Children

House Bill 3548 (Rep. Dutton/Sen. Rodriguez)

HB 3548 would have allowed pharmacists to administer all CDC-recommended vaccines – including tetanus, diphtheria and pertussis (Tdap), meningococcal and human papillomavirus (HPV) – under a physician’s protocol without a prescription to anyone 7 years of age or older.

 

Pharmacists Checking PMP on Refills

Senate Bill 420 (Sen. Buckingham/Rep. S. Thompson)

SB 420 would have clarified that pharmacists are not required to check the Prescription Monitoring Program (PMP) for refill prescriptions for opioids, benzodiazepines, barbiturates, or carisoprodol.

 


Pharmacy Defensive Victories

TPA and other pharmacy organizations worked hard to defeat the following bills that would have hurt the practice of pharmacy, often despite well-organized opposition.

 

Physician Dispensing

HB 1622 (Rep. Oliverson) and HB 460 (Rep. Shaheen) would have allowed physicians to dispense medications from their office, which would have threatened patient health and safety by not requiring the same high standards as pharmacist dispensing or the same Texas State Board of Pharmacy oversight to protect patients.

 

Broad Telepharmacy Expansion

HB 1706 (Rep. Oliverson) would have allowed a telepharmacy to be located in an ambulatory surgical center, a birthing center, a community health center, a hospital, or an outpatient clinic in a community in which a Class A or Class C pharmacy is located. HB 4266 (Rep. Zedler) would have reduced the requirement that a telepharmacy cannot be within 25 miles of a Class A pharmacy to 5 miles. SB 2377 (Sen. Hughes) would have reduced the limit to 10 miles. These bills would have loosened location mileage requirements for telepharmacies in areas that were not rural and did not lack access to pharmaceutical care due to a shortage of pharmacists.

 

Opioid Overreach

HB 536, HB 562, and HB 563 (Rep. Thierry) would have required red caps on all opioid prescriptions, opioid warning labels in 14-point type, and patient consent forms for opioid dispensing, which would have caused burdensome requirements for pharmacists. HB 2086 (Rep. Dean) would have required pharmacies to take back controlled substances and bear the cost of opioid disposal by installing disposal kiosks.

 


Other Passed Bills of Interest

The following bills passed this session that may be of interest to pharmacists and pharmacy owners.

 

Tobacco 21

Senate Bill 21 (Sen. Huffman/ Rep. Zerwas)

SB 21 raises the legal smoking and vaping age in Texas to 21 years. Those younger than 21 who possess, use, or try to buy e-cigarettes or other tobacco products could receive a $100 fine. The bill exempts active-duty members of U.S. and state military forces who are at least 18 years old if they present a military ID card at the time of purchase. Retailers who conduct underage tobacco or vape sales three times in a 12-month period are subject to loss of license to sell these products.

Effective Date: September 1, 2019 [signed into law by Governor Abbott]

 

Medicinal Cannabis Expansion

House Bill 3703 (Rep. Klick/Sen. Campbell)

HB 3703 expands the list of conditions that qualify for medicinal cannabis to include all forms of epilepsy, seizure disorders, multiple sclerosis, spasticity, amyotrophic lateral sclerosis (ALS), terminal cancer, autism, and incurable neurodegenerative diseases. It also removes the requirement that those seeking the medicine need the approval of two licensed neurologists, rather than one.

Effective Date: Immediate upon Governor’s approval

 

State Hemp Production

House Bill 1325 (Rep. T. King/Sen. Perry)

HB 1325 legalizes hemp and hemp-derived extracts like CBD oil as long as they contain no more than 0.3% of tetrahydrocannabinol (THC), the psychoactive element in marijuana. While hemp-based products that contain no THC — like clothing and twine, protein powder, moisturizers and essential oils — are legal in the state, the plant under current law cannot be legally grown here, and Texas businesses often source it from other states.

Effective Date: September 1, 2019

 

Drug-Price Transparency

House Bill 2536 (Rep. Oliverson/Sen. Hancock)

HB 2536 requires the Health and Human Services Commissioner to establish a website that contains pricing information for prescription drugs with a wholesale acquisition cost of at least $100 for a 30-day supply. Pharmaceutical manufacturers must provide this data by January 15 each year and provide an update each time a drug increases more than 15 percent in a year, or more than 40 percent over three years. Pharmacy benefit managers (PBMs) must report to the Commissioner the aggregated rebates, fees, price protection payments and any other payments collected from pharmaceutical manufacturers that were passed to health benefit plans or enrollees at point of sale of a prescription drug or retained as revenue by the PBM. The first report is due by February 1, 2020 to account for the previous three calendar years, and annually thereafter. The Commissioner shall publish the aggregated data from all reports on the website. The report will not disclose proprietary or confidential information of any PBM. Health Benefit Plan Issuers shall submit by February 1 of each year a report for the previous calendar year’s 25 most frequently prescribed prescription drugs; percent increase in annual net spending for prescription drugs; percent increase in premiums that were attributable to prescription drugs; percentage of specialty drugs with utilization management requirements; and premium reductions attributable to specialty drug utilization management. This report may not disclose the identity of a specific plan or price charged of a specific drug or class of drugs. The Commissioner shall publish the aggregated date from all reports by May 1 of each year. No proprietary data may be disclosed by this report.

Effective Date: September 1, 2019

 

Medicaid Medication-Assisted Treatment for Opioid Use Disorder

Senate Bill 1564 (Sen. West/Rep. Klick)

SB 1564 better aligns the state's Medicaid policy with federal law by providing Medicaid medical benefits reimbursement for the prescribing of buprenorphine by certain advanced practice registered nurses.

Effective Date: September 1, 2019

 

Stage Four Cancer

House Bill 1584 (Rep. S. Thompson/Sen. Buckingham)

HB 1584 prohibits health plans from requiring “fail first” step therapy protocols for prescription drugs for patients with stage-four advanced, metastatic cancer.

Effective Date: September 1, 2019

 

Property Tax Reform

Senate Bill 2 (Sen. Bettencourt/Rep. Burrows)

SB 2, The Texas Property Tax Reform and Transparency Act requires cities, counties, and other taxing units to receive voter approval before levying 3.5% more property tax revenue than the previous year. Community colleges, hospital districts and units with the lowest rates (up to 2.5 cents per $100 valuation) must also obtain voter approval before surpassing 8% revenue growth. The measure also creates an online database to show property owners how proposed rate changes would affect their bills and make it easy to comment on increases using an automatically generated online form. The database would also include information about when public hearings are held to set local tax rates.

Effective Date: January 1, 2020, certain sections of the bill have later effective dates

 

Concealed Carry During Disaster

House Bill 1177 (Rep. Phelen/Sen. Creighton)

HB 1177 allows Texans without a license-to-carry to carry their firearms when their property is under a mandatory order evacuation issued during a state of disaster.

Effective Date: September 1, 2019

Licensing

Senate Bill 1217 (Sen. Alvarado/Rep. Morales)

SB 1217 prohibits licensing boards from considering an arrest that did not result in the person’s conviction or placement on deferred adjudication community supervision in determining an applicant’s eligibility for an occupational license.

Effective Date: Immediate upon Governor’s approval


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PharmPAC is the political action committee of the Texas Pharmacy Association, 3200 Steck Ave. #370, Austin, TX 78757. Call (512) 836-8350 for information. According to Texas Government Code 305.027, this material may be considered “legislative advertising.” Authorization for its publication is made by Debbie Garza, Chief Executive Officer, Texas Pharmacy Association.

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