SECTION 354.1877. Quantity Limitations

(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.

Source Note: The provisions of this §354.1877 adopted to be effective May 1, 2012, 36 TexReg 6717