Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 28 - PHARMACY SERVICES: REIMBURSEMENT
Section 355.8541 - Legend and Nonlegend Medications

Universal Citation: 1 TX Admin Code ยง 355.8541

Current through Reg. 49, No. 38; September 20, 2024

(a) Legend and nonlegend drug reimbursement. A pharmaceutical provider is reimbursed for legend and nonlegend drugs based on the lesser of the:

(1) acquisition cost (AC) plus the Health and Human Services Commission's (HHSC's) currently established professional dispensing fee per prescription;

(2) usual and customary price charged the general public; or

(3) Gross Amount Due, if provided.

(b) AC. The AC is verifiable by invoice audit conducted by HHSC to include necessary supporting documentation that will verify the final cost to the provider.

(c) Public hearing. Notice of a public hearing to receive comments on proposed changes to general pricing determinations derived under this section will be published in the Texas Register.

(d) Definitions. The terms used in this section have the meanings as defined for the same terms in § RSA 354.1921(g) of this title (relating to Addition of Drugs to the Texas Drug Code Index).

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