Texas Administrative Code (Last Updated: February 21,2024) |
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
Latest version.
-
(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 §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. Source Note: The provisions of this §353.911 adopted to be effective March 1, 2012, 37 TexReg 1292