Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter J - OUTPATIENT PHARMACY SERVICES
Section 353.911 - Members
Current through Reg. 49, No. 38; September 20, 2024
(a) A member must obtain a covered outpatient drug from a network pharmacy provider contracted with the member's health care MCO, except at provided in § RSA 353.913 of this subchapter (relating to Managed Care Organization Requirements Concerning Out-of-network Outpatient Pharmacy Services).
(b) A member may receive up to a 90-day supply of a covered outpatient drug.
(c) A health care MCO cannot require a member to obtain a specialty drug or other covered outpatient drug from a mail-order pharmacy unless a mail-order pharmacy is the only available dispensing source for the drug. A health care MCO cannot charge the member for mail-order services, including the cost of the drug, fees, or other related services.
