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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 353 - MEDICAID MANAGED CARE
SUBCHAPTER J - OUTPATIENT PHARMACY SERVICES
SECTION/RULE §353.911 - Members
Chapter Review Date 04/25/2024

(a) A member must obtain a covered outpatient drug from a network pharmacy provider contracted with the member's health care MCO, except at provided in §353.913 of this subchapter (relating to Managed Care Organization Requirements Concerning Out-of-network Outpatient Pharmacy Services).(b) A member may receive up to a 90-day supply of a covered outpatient drug.(c) A health care MCO cannot require a member to obtain a specialty drug or other covered outpatient drug from a mail-order pharmacy unless a mail-order pharmacy is the only available dispensing source for the drug. A health care MCO cannot charge the member for mail-order services, including the cost of the drug, fees, or other related services.

Source Note: The provisions of this §353.911 adopted to be effective March 1, 2012, 37 TexReg 1292.

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