Tex.
Gov't Code Section 540.0277
Pharmacy Benefit Plan: Pharmacy Benefit Providers
(a)
A Medicaid managed care organization’s pharmacy benefit plan required by Section 540.0273 (Outpatient Pharmacy Benefit Plan) in a contract to which this subchapter applies must allow the organization or any subcontracted pharmacy benefit manager to contract with a pharmacist or pharmacy providers separately for specialty pharmacy services, except that:(1)
the organization and pharmacy benefit manager are prohibited from allowing exclusive contracts with a specialty pharmacy owned wholly or partly by the pharmacy benefit manager responsible for administering the pharmacy benefit program; and(2)
the organization and pharmacy benefit manager must adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that:(A)
are consistent with rules the executive commissioner adopts; and(B)
include notice to network pharmacy providers from the organization.(b)
A Medicaid managed care organization, under the organization’s pharmacy benefit plan required by Section 540.0273 (Outpatient Pharmacy Benefit Plan) in a contract to which this subchapter applies:(1)
may not prevent a pharmacy or pharmacist from participating as a provider if the pharmacy or pharmacist agrees to comply with the financial terms, as well as other reasonable administrative and professional terms, of the contract;(2)
may include mail-order pharmacies in the organization’s networks, but may not require enrolled recipients to use those pharmacies; and(3)
may not charge an enrolled recipient who opts to use a mail-order pharmacy a fee, including a postage or handling fee.
Source:
Section 540.0277 — Pharmacy Benefit Plan: Pharmacy Benefit Providers, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.540.htm#540.0277 (accessed Jun. 5, 2024).
