Tex.
Gov't Code Section 531.072
Preferred Drug Lists
(a)
In a manner that complies with applicable state and federal law, the commission shall adopt preferred drug lists for the Medicaid vendor drug program and for prescription drugs purchased through the child health plan program. The commission may adopt preferred drug lists for community mental health centers, state mental health hospitals, and any other state program administered by the commission or a state health and human services agency.(b)
The preferred drug lists may contain only drugs provided by a manufacturer or labeler that reaches an agreement with the commission on supplemental rebates under Section 531.070 (Supplemental Rebates).(b-1)
Notwithstanding Subsection (b), the preferred drug lists may contain:(1)
a drug provided by a manufacturer or labeler that has not reached a supplemental rebate agreement with the commission if the commission determines that inclusion of the drug on the preferred drug lists will have no negative cost impact to the state; or(2)
a drug provided by a manufacturer or labeler that has reached an agreement with the commission to provide program benefits in lieu of supplemental rebates, as described by Section 531.070 (Supplemental Rebates).(b-2)
Consideration must be given to including all strengths and dosage forms of a drug on the preferred drug lists.(b-3)
Notwithstanding Subsection (b), the preferred drug lists must contain all therapeutic equivalents for a generic drug on the preferred drug list.(c)
In making a decision regarding the placement of a drug on each of the preferred drug lists, the commission shall consider:(1)
the recommendations of the Drug Utilization Review Board under Section 531.0736 (Drug Utilization Review Board);(2)
the clinical efficacy of the drug;(3)
the price of competing drugs after deducting any federal and state rebate amounts; and(4)
program benefit offerings solely or in conjunction with rebates and other pricing information.(c-1)
In addition to the considerations listed under Subsection (c), the commission shall consider the inclusion of multiple methods of delivery within each drug class, including liquid, tablet, capsule, and orally disintegrating tablets.(d)
The commission shall provide for the distribution of current copies of the preferred drug lists by posting the list on the Internet. In addition, the commission shall mail copies of the lists to any health care provider on request of that provider.(e)
In this subsection, “labeler” and “manufacturer” have the meanings assigned by Section 531.070 (Supplemental Rebates). The commission shall ensure that:(1)
a manufacturer or labeler may submit written evidence supporting the inclusion of a drug on the preferred drug lists before a supplemental agreement is reached with the commission; and(2)
any drug that has been approved or has had any of its particular uses approved by the United States Food and Drug Administration under a priority review classification will be reviewed by the Drug Utilization Review Board at the next regularly scheduled meeting of the board. On receiving notice from a manufacturer or labeler of the availability of a new product, the commission, to the extent possible, shall schedule a review for the product at the next regularly scheduled meeting of the board.(f)
A recipient of drug benefits under the Medicaid vendor drug program may appeal a denial of prior authorization under Section 531.073 (Prior Authorization for Certain Prescription Drugs) of a covered drug or covered dosage through the Medicaid fair hearing process.(g)
The commission shall develop an expedited review process to consider requests from managed care organizations and providers to add drugs to the preferred drug list.(h)
The commission shall grant temporary non-preferred status to new drugs that are available but have not yet been reviewed by the drug utilization review board and establish criteria for authorizing drugs with temporary non-preferred status.(b-3)
Notwithstanding Subsection (b), the preferred drug lists must contain all therapeutic equivalents for a generic drug on the preferred drug list.(g)
The commission shall develop an expedited review process to consider requests from managed care organizations and providers to add drugs to the preferred drug list.(h)
The commission shall grant temporary non-preferred status to new drugs that are available but have not yet been reviewed by the drug utilization review board and establish criteria for authorizing drugs with temporary non-preferred status.
Source:
Section 531.072 — Preferred Drug Lists, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.531.htm#531.072 (accessed Jun. 5, 2024).
