SECTION 354.1042. Supplies Provided by a Pharmacy

(a) Certain supplies that are covered benefits of Texas Medicaid may be provided by a pharmacy enrolled in the Medicaid Vendor Drug Program (VDP) as described in this section.

(b) Covered supplies include medical equipment or products typically obtained through a pharmacy with a valid prescription that are designated by the Health and Human Services Commission (HHSC) or its designee. A list of covered supplies can be found on HHSC's website at http://www.txvendordrug.com. The list includes insulin syringes and needles, which are also described in §354.1039 of this division (relating to Home Health Services Benefits and Limitations).

(c) The supplies covered under this section may be reimbursed through the Vendor Drug Program (VDP) if a claim is properly submitted and complies with this section.

(d) The supplies covered under this section require a valid prescription and do not require prior authorization unless otherwise specified in HHSC policy. A prescription for supplies covered under this section is valid for six months.

(e) The supplies covered under this section are subject to the limitations defined in the Texas Medicaid Provider Procedures Manual. Exceptions to these limitations require authorization by HHSC.

(f) Supplies covered under this section must be:

(1) Supported by medical literature or evidence-based practice guidelines indicating the use of the supply in the treatment of a disease or condition;

(2) Billed by the pharmacy using a National Drug Code number; and

(3) Eligible for federal financial participation under the Medicaid program.

(g) Supplies covered under this section are not reimbursable through the VDP if they are:

(1) Obtained through a Medicaid home health or durable medical equipment supplier under the same valid prescription or order; or

(2) Provided to clients who reside in a long-term care facility or are enrolled in Medicaid managed care, except clients enrolled in Primary Care Case Management.

Source Note: The provisions of this §354.1042 adopted to be effective May 1, 2012, 36 TexReg 6717