Third-Party Discount Plans

Some pharmacies honor discount prices advertised to cash-paying customers by third-parties. Pharmacies may or may not contract with third-parties to adjudicate and administer these discounts.

Only people whose prescriptions are paid by third party payers, such as health insurers, governmental entities and Texas Medicaid, are excluded from the general public. Refer to TAC Section 355.8544 (Subchapter J: Usual and Customary Prices).

The involvement of a third-party in offering, advertising, adjudicating, or administering the discount price a person pays does not remove the person from the general public, and the third-party discount price must be included in the UAC price determination if honored by the pharmacy.

As with pharmacy discount membership programs, the requirement a person pay a nominal fee to enroll in the third-party’s discount program does not remove the person from the general public or otherwise exempt the discount price from the UAC price determination. Some third-party discount plan prices are only offered to segments of the general public, such as discount plans for senior adults, employees/retirees of companies, etc. These discount prices must be included in the UAC price determination if the person would have qualified as a member of the same group or segment of the public, but-for the person’s status as a Texas Medicaid beneficiary.

Refer to the Usual and Customary section for the definition of the UAC price.