D-2.4.1. Ends Day 30

The HHSC pharmacist estimates the fiscal impact by doing the following:

1. Calculating the estimated number of prescriptions by multiplying the estimated number of people who may use the drug by the average number of prescriptions per year.
2. Calculating the estimated cost by multiplying the estimated number of prescriptions by the cost per prescription.
3. Calculating the federal financial participation and general revenue (GR) of the estimated costs determined above.
4. For orphan drugs and any drug for which the estimated GR FFS cost meets or exceeds $500,000 per state fiscal year or results in a managed care capitation rate adjustment, engages Forecasting staff for further evaluation:
   1. If there is potential for a drug to equal or exceed $500,000 GR FFS costs per state fiscal year or result in a managed care capitation rate adjustment, then the drug is referred to Forecasting for further analysis.
   2. If VDP identifies the drug as an orphan, then the drug is added to the TDCI. VDP will coordinate with Forecasting to prepare and submit the required orphan drug notification within 60 days as required under Special Provision 17. As noted above, LBB is not required to approve orphan drugs.