Deadline for Draft Policy Review Due Oct. 5

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The HHSC Vendor Drug Program (VDP) accepts stakeholder comments on the following draft policy. The comment period ends Oct. 5, 2023. Submit your comments using the Draft Policy Comment Submission (HHS Form 1342). VDP will consider the comments in the development of the final policy. 

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Draft Policy

HB 916, 88th Legislature, amended Section 1369.102 of the Texas Insurance Code to require health benefit plans, including Medicaid managed care organizations, to allow the Medicaid member to obtain covered prescription contraceptives following the criteria specified below: 

  1. Medicaid will reimburse the pharmacy for the drug up to a three-month supply the first time the member obtains the drug.
  2. Medicaid will reimburse up to a twelve-month supply of the covered prescription contraceptive drug each time after the member obtains the same drug. VDP defines “same drug” as a drug that can be therapeutically substituted (multiple formulations, strengths, and NDCs).
  3. Members can receive one 12-month supply of a covered prescription contraceptive drug during each 12-month calendar period. This applies regardless of whether the member was enrolled in the health benefit plan the first time they obtained the drug. For example, if a member enrolls in a different health plan after obtaining the initial fill, they can receive the 12-month supply without repeating the initial fill that is limited to a three-month supply.
  4. Covered prescription contraceptives includes drugs that are on the Medicaid formulary.
  5. This bill does not apply to the Children’s Health Insurance Program (CHIP).

Medicaid fee-for-service and Medicaid managed care organizations will implement this change by Jan. 1, 2024.