SECTION 355.8541. Legend and Nonlegend Medications

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(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 §354.1921(g) of this title (relating to Addition of Drugs to the Texas Drug Code Index).

Source Note: The provisions of this §355.8541 adopted to be effective October 21, 2001, 26 TexReg 8020; amended to be effective January 14, 2013, 37 TexReg 8467; amended to be effective May 15, 2016, 41 TexReg 3300; amended to be effective April 15, 2019, 44 TexReg 1837

                    
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