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Current as of January 01, 2024 | Updated by Findlaw Staff
(a) A Medicaid managed care organization's pharmacy benefit plan required by Section 540.0273 in a contract to which this subchapter applies must allow the organization or any subcontracted pharmacy benefit manager to contract with a pharmacist or pharmacy providers separately for specialty pharmacy services, except that:
(1) the organization and pharmacy benefit manager are prohibited from allowing exclusive contracts with a specialty pharmacy owned wholly or partly by the pharmacy benefit manager responsible for administering the pharmacy benefit program; and
(2) the organization and pharmacy benefit manager must adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that:
(A) are consistent with rules the executive commissioner adopts; and
(B) include notice to network pharmacy providers from the organization.
(b) A Medicaid managed care organization, under the organization's pharmacy benefit plan required by Section 540.0273 in a contract to which this subchapter applies:
(1) may not prevent a pharmacy or pharmacist from participating as a provider if the pharmacy or pharmacist agrees to comply with the financial terms, as well as other reasonable administrative and professional terms, of the contract;
(2) may include mail-order pharmacies in the organization's networks, but may not require enrolled recipients to use those pharmacies; and
(3) may not charge an enrolled recipient who opts to use a mail-order pharmacy a fee, including a postage or handling fee. (Gov. Code, Secs. 533.005(a)(23)(G), (H), (I).)
Cite this article: FindLaw.com - Texas Government Code - GOV'T § 540.0277. Pharmacy Benefit Plan: Pharmacy Benefit Providers - last updated January 01, 2024 | https://codes.findlaw.com/tx/government-code/gov-t-sect-540-0277/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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