S-1. Specialty Drugs

HHSC defines a specialty drug as one meeting all of the Specialty Drug rule criteria.  The specialty drug list (SDL) identifies all drugs meeting these criteria.  HHSC publishes the SDL in March and Sept., but we may consider off-cycle updates to address drug shortages.

Refer questions or comments about specialty drugs to vdp-formulary@hhsc.state.tx.us.

Information for pharmacies

• Any Medicaid-enrolled pharmacy can dispense a drug identified on the SDL for people enrolled in traditional Medicaid. 
• A pharmacy may need to enroll in an MCO’s specialty pharmacy network to dispense a drug identified on the SDL.

Information for managed care organizations:

• Medicaid managed care organizations and subcontracted pharmacy benefit managers are required to adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that are consistent with rules adopted by the HHSC Executive Commissioner. Refer to Texas Government Code, section 533.005(a)(23)(G).
• The only drugs exclusively provided through the MCO’s specialty pharmacy network are those listed on the SDL. 
• MCOs will have three months after a drug is removed from the published SDL to adjust contracts.

Information for prescribing providers:

• Prescribing providers may be asked to send prescriptions for drugs on the SDL to an MCO’s specialty pharmacy network
• Some drugs identified on the SDL may require clinical or non-preferred prior authorization