RESPONSE: The commission disagrees that the rule requires the recommended additional language but does agree that the TWCC Form 66a, the commission pharmacy billing form, should be revised to provide for the requirement of the NDC numbers for the generic drug prescribed and brand name drug dispensed.

COMMENT: Commenters recommended deleting subparagraphs (A) and (B) from §134.503(b)(2) and substituting the following language: "by the employee for the entire fee established for the brand name drug in accordance with §134.503(a)(2) of this title."

RESPONSE: The commission disagrees. Section 408.028 of the Act, as amended by HB833, states that the injured employee is be responsible for paying the difference between the cost of the brand name drug and the cost of the generic pharmaceutical medication or of an over-the-counter alternative to a prescription medication. There is no statutory provision for the injured employee to pay the entire fee established for the brand name drug.

§134.504(b)

COMMENT: Commenter recommended that language be added to subsection (b) that requires the injured employee to pay the full cost of brand name drugs and to seek reimbursement from the employer, insurance carrier, or claims administrator. Commenter further suggested that the pharmacist would then only need to provide receipts and documentation to assist the injured employee in obtaining this reimbursement from the carrier.

RESPONSE: The commission disagrees. Section 408.028 of the Act, as amended by HB833, does not give the commission the discretion to adopt a rule that includes the recommended language.

These amendments are adopted pursuant to Texas Labor Code §402.042, which authorizes the Executive Director to enter orders as authorized by the statute as well as to prescribe the form and manner and procedure for transmission of information to the commission; Texas Labor Code §402.061, which authorizes the commission to adopt rules necessary to administer the Act; Texas Labor Code §406.010, which authorizes the commission to adopt rules necessary to specify the requirements for carriers to provide claims service and establishes that a person commits a violation if the person violates a rule adopted under this section; Texas Labor Code §408.021(a), which provides that an employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed; Texas Labor Code §408.025, which requires the commission to specify by rule what reports a health care provider is required to file; and Texas Labor Code §408.028, which requires health care practitioners providing care to an employee to prescribe any necessary prescription drugs in accordance with applicable state law.

These amended rules are adopted under: Texas Labor Code §402.042, §402.061, §406.010, §408.021(a), §408.025, and §408.028.

The previously cited sections of the Texas Labor Code are affected by this adopted rule action. No other code, statute, or article is affected by this rule action.