The following information was obtained from the January 27 issue of the Texas Register.
HHSC proposed new §354.1853, Specialty Drugs, which provides a definition and criteria for specialty drugs. An excerpt:
Section 1.02(d), Senate Bill 7, 82nd Legislature, First Called Session, 2011, amends Texas Government Code §533.005(a) by adding paragraph (23)(G) to require Medicaid managed care organizations (MCOs) and subcontracted pharmacy benefit managers (PBMs) to adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that are consistent with rules adopted by the Executive Commissioner. MCOs and subcontracted PBMs cannot individually determine which retail drugs to reclassify as specialty drugs but will instead be required to follow HHSC’s specialty drugs list, as described in the proposed new rule.
