Specialty Drugs

Traditional Medicaid

Specialty drugs on the biannual Specialty Drug List (SDL) are available as either an outpatient pharmacy benefit, a medical or physician benefit, or both.

Refer to the Texas Medicaid Provider Procedure Manual for brand/generic availability, diagnosis restrictions, and billing information of products covered as a medical/physician benefit. Contact TMHP for form submission requirements.

Medicaid managed care

HHSC provides the SDL to MCOs to identify specialty drugs offered exclusively through the MCO's specialty pharmacy network.

Refer to the Specialty Drug Handbook for the specialty drug rule, how to provide input for the SDL, and the SDL publication schedule.