Pharmacy benefit manager (PBM) fees that take millions of dollars from Texas practices are just one signature away from being outlawed following Senate passage of one of the House of Medicine’s priority measures during a furiously active Thursday afternoon at the Capitol.
The Senate passed House Bill 1763 by Rep. Tom Oliverson, MD (R-Cypress), which would prohibit PBMs from using direct and indirect remuneration (DIR) fees to “claw back” money from pharmacies after the finalization of an insurance claim. The Texas Medical Association testified in favor of the bill earlier this session, with Austin oncologist Debra Patt, MD, telling lawmakers DIR fees had cost her clinic more than $16 million in 2020 alone.
After it passed the House by a unanimous vote in April, HB 1763 had little trouble in the Senate as well, also passing unanimously. It now moves to Gov. Greg Abbott’s desk.
House passes ban on white-bagging for cancer drugs
Facing Thursday’s deadline in the House for House-originated bills to reach second reading or die, a TMA-supported bill that would ban so-called “white-bagging” stayed alive. Then, on Friday, it passed in amended form after being applied strictly to cancer care.
House Bill 1586 by Rep. Eddie Lucio III (D-Brownsville) now bars health plans and specialty pharmacies from requiring physicians’ offices, among other facilities, to obtain specialty cancer drugs from a pharmacy in the insurer’s network. HB 1586 earned second reading Thursday following a TMA alert to House members urging them to support it. It then passed the House on Friday afternoon by a 122-19 vote after Rep. Ramon Romero Jr. (D-Fort Worth) proposed the cancer-specific amendment.
Some other TMA-supported bills on the Thursday House calendar, however, didn’t make it out. House Bill 2241 by Representative Oliverson to strengthen the prudent layperson standard in emergency care is no longer eligible for advancement. Also on Thursday’s calendar, but failing to reach second reading, was House Bill 980 by Rep. Arthur Fierro (D-El Paso) to ensure payment parity in telemedicine services.
Medicine brokers deal, avoids optometrist surgery authority
Senate Bill 993 by Sen. Kelly Hancock (R-North Richland Hills), originally a troubling bill that would have allowed optometrists to perform several types of surgeries, no longer has that language thanks to an agreement involving the Texas Ophthalmological Association (TOA) and organized optometry.
The deal on SB 993 preceded its passage Thursday afternoon in the Senate, alleviating the House of Medicine’s concerns about the bill. It passed with no surgery authority for optometrists, and the current version also doesn’t give optometrists the authority to prescribe narcotics, or any other medications beyond treatment for the eye, according to a letter to TOA members Thursday from society President Mark L. Mazow, MD.
As passed in the Senate, Dr. Mazow explained, the bill does expand optometrists’ use of topical and oral eye medications; allows optometrists to medically manage moderate and less severe forms of glaucoma without co-management with an ophthalmologist; and creates a new peer review process for glaucoma complaints made to the Texas Optometry Board.
“Given the climate and the unique challenges we faced this year, I am proud of our executive council for coming to the table and finding a solution that has mitigated the original proposal while simultaneously improving guardrails for glaucoma patients,” Dr. Mazow’s letter said.
Barring some 11th-hour action, last week’s agreement takes one of medicine’s primary scope-of-practice concerns for this session off the table. Sen. Dawn Buckingham, MD (R-Lakeway), an oculoplastic surgeon, was a major part of brokering the agreement.
Committee OK’s “treat till transfer” bill
The news wasn’t as good Thursday coming out of the Senate Health & Human Services Committee, which approved a bill that could force physicians to indefinitely provide medically inappropriate end-of-life care.
Senate Bill 917 by Rep. Bryan Hughes (R-Tyler) would scrap the 10-day period to find a transfer destination for a patient on life-sustaining treatment that follows a hospital ethics committee decision that the care is medically inappropriate.
TMA sees the ethics-committee process and the 10-day transfer period as key pieces of the state’s current Advance Directives Act. But under SB 917, there would be no finite transfer-searching period after which the physician could withdraw the treatment without facing civil or criminal liability. In other words, physicians will be forced to continue searching for a transfer location that is often never found, or continue treating the patient despite their moral and ethical misgivings.
TMA remains committed to making sure physicians can act on their conscience and medical judgment in end-of-life situations and opposes SB 917 as currently written.