Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter F - PHARMACY SERVICES
Division 4 - LIMITATIONS
Section 354.1877 - Quantity Limitations
Universal Citation: 1 TX Admin Code ยง 354.1877
Current through Reg. 49, No. 38; September 20, 2024
(a) Quantity. The quantity of drugs prescribed depends on the prescribing practice of the prescriber and the needs of the patient.
(1)
For recipients with monthly prescription limitations, the Vendor Drug Program
(VDP) reimburses the provider for the prescribed quantity, up to but not
exceeding a six-month supply.
(2)
For recipients with access to unlimited prescriptions, the VDP reimburses the
provider dispensing a medication for a quantity that does not exceed a
one-month (34-day) supply.
(b) Refills. Except for medications that may be too unstable to be dispensed as a one-month supply, the Health and Human Services Commission requires that the same drug in the same strength be dispensed no more than once per month. The dispensing of authorized refills must be consistent with the prescribed dosage schedule and existing federal and state laws.
(1) To be reimbursed by the VDP,
a refill must be dispensed only after 75 percent of a previous dispensing of
the same prescription would have been used if taken according to the
accompanying prescriber's orders. A higher percentage limit may be required for
a drug that has been determined to be subject to abuse or overuse.
(2) A recipient may obtain an early
medication refill for a justifiable reason.
(A) A justifiable reason includes, but is not
limited to, a dosage increase or an anticipated prolonged absence from the
community. The reason must be noted on the prescription.
(B) Unless specific authorization is obtained
from the prescriber, breakage, spillage, or loss of a medication are not
considered justifiable reasons. The prescription obtained under this
authorization is considered a new prescription.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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