Texas Government Code §533.005(a)(23)(G), as added by Section 1.02(d), Senate Bill 7, 82nd Legislature, First Called Session, 2011, requires 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 drugs to classify as specialty drugs, but are instead required to follow HHSC’s specialty drugs list, as described in the rule, 1 TAC §354.1853.
The list of specialty drugs was developed by the Texas Health and Human Services Commission and follows the criteria set forth in the specialty drug rule (1 TAC §354.1853). This list includes drugs that are on the Vendor Drug formulary or provided through the Texas Medicaid medical benefit.
The state will update the specialty drug list quarterly, and take into consideration any comments and suggestions that stakeholders provide when HHSC updates the list. Updates to this list will be announced to stakeholders through our newsletter and the HHSC email subscription service.