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Texas Government Code - GOV'T § 549.0258. Prior Authorization Automation and Point-of-Sale Requirements

Current as of January 01, 2024 | Updated by Findlaw Staff

The executive commissioner, in the rules and standards governing the vendor drug program and as part of the requirements under a contract between the commission and a Medicaid managed care organization, shall:

(1) require, to the maximum extent possible based on a pharmacy benefit manager's claim system, automation of clinical prior authorization for each drug in the antipsychotic drug class;  and

(2) ensure that, at the time a nonpreferred or clinical prior authorization edit is denied, a pharmacist is immediately provided a point-of-sale return message that:

(A) clearly specifies the contact and other information necessary for the pharmacist to submit a prior authorization request for the prescription;  and

(B) instructs the pharmacist to dispense, only if clinically appropriate under federal or state law, a 72-hour supply of the prescription.

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Cite this article: FindLaw.com - Texas Government Code - GOV'T § 549.0258. Prior Authorization Automation and Point-of-Sale Requirements - last updated January 01, 2024 | https://codes.findlaw.com/tx/government-code/gov-t-sect-549-0258/

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