SECTION 353.909. Participating Pharmacy Providers

(a) To participate in a health care MCO's network, a pharmacy provider must be licensed with the Texas State Board of Pharmacy, have a national provider identifier, and be enrolled as a Medicaid provider with HHSC. To provide services to a member of a MCO when the member is located in another state, the pharmacy provider must be licensed with the pharmacy licensing entity in that state, have a national provider identifier, and be enrolled as a Medicaid provider with HHSC.

(b) A pharmacy provider is subject to the Vendor Drug Program rules in Chapter 354, Subchapter F, Division 1 and Division 5 of this title (relating to Participation; and Audits).

(c) The prescription requirements in §354.1863(a), (b), and (d) of this title (relating to Prescription Requirements) apply to all pharmacy providers.

(d) Except as prohibited by the health care MCO, a pharmacy provider may substitute one covered outpatient drug for another covered outpatient drug in a prescription only if authorized by the prescribing physician in accordance with 22 TAC §309.3 (relating to Generic Substitution).

Source Note: The provisions of this §353.909 adopted to be effective March 1, 2012, 37 TexReg 1292; amended to be effective September 1, 2014, 39 TexReg 5873