TEXAS MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution 404 (A-06)
Subject: Texas Medicaid/CHIP Vendor Drug Program
Introduced by: John R. Asbury, MD
Referred to: Reference Committee on Socioeconomics
Whereas, The Texas Health and Human Services Commission operates the Texas Medicaid/Children's Health Insurance Program (CHIP) Vendor Drug Program as a way to provide better care to Texas Medicaid patients; and
Whereas, The reimbursement rate for treating Medicaid patients makes it necessary for physicians to be time-efficient when seeing these patients; and
Whereas, Attaining approval from the Vendor Drug Program for nonapproved medications requires time-consuming phone calls by physicians; and
Whereas, Certain forms and formulations of drugs are not covered while others are; and
Whereas, The list of covered drugs is not updated on a timely basis, requiring extensive investigation to ascertain whether a medication that a physician prescribed previously still qualifies for coverage; therefore be it
RESOLVED, That the Council on Socioeconomics conduct a study to ascertain how the Texas Medicaid/CHIP Vendor Drug Program can become more efficient for Texas physicians to use and that the council report its findings to the House of Delegates in a timely manner and forward the findings to the Texas Health and Human Services Commission so that it can improve the care of Texans affected by the Vendor Drug Program.
Relevant TMA Policy
190.023 Policy Principles for Medicaid and CHIP Legislative Initiatives . The Texas Medical Association adopted the following policy principles to guide the evaluation of emerging Medicaid and CHIP budget and legislative initiatives and association advocacy efforts: …
- Advocate simplification of the Medicaid Preferred Drug List, including an open, accessible process for classifying drugs as preferred or nonpreferred:
- Require use of generic drugs when available; all generics would be available without prior authorization unless there is a safety concern.
- For brand name drugs, continue use of the supplemental rebate process, but apply it only to drugs whose properties are available in more than one product (e.g., Lantus is the only long-acting insulin, but it requires prior authorization because the manufacturer refused to provide a rebate. Under this proposal, Lantus would remain available. If another brand or generic became available with the same properties, then HHSC could seek a supplemental rebate process so long as at least one drug with the needed properties remained available without prior authorization).
- Promote publication of the relative price of Medicaid and CHIP drugs so that physicians are aware of the costs of prescribed drugs.
- Promote physician "counter detailing" to encourage evidence-based prescribing of prescription drugs and long-term changes in physician prescribing behavior.
- Require the HHSC Pharmaceutical and Therapeutics (P&T) Committee to conduct clinical and safety discussions in public to assure that stakeholders understand rationale for classifying a drug as preferred or nonpreferred.
- Establish a formal appeal mechanism when drugs are not approved based on quality.
- Require the P&T Committee to establish liaisons to specialty physician organizations to assure broader clinical input regarding drugs on the Preferred Drug List. … (AHCM-MAC Rep. 1-I-04).
TMA House of Delegates: TexMed 2006
Last Updated On
July 06, 2010
Originally Published On
March 23, 2010