Division 3: Texas Standard Prior Authorization Request Form For Prescription Drug Benefits

• Section 19.1820: Prior Authorization Request Form For Prescription Drug Benefits, Required Acceptance, And Use

• Section 353.901: Purpose
• Section 353.903: Definitions
• Section 353.905: Managed Care Organization Requirements
• Section 353.907: Prior Authorization Requirements
• Section 353.909: Participating Pharmacy Providers
• Section 353.911: Members
• Section 353.913: Managed Care Organization Requirements Concerning Out-of-Network Outpatient Pharmacy Services
• Section 353.915: Access to Network Pharmacies

Division 3: Medicaid Home Health Services

• Section 354.1031: General
• Section 354.1035: Recipient Qualifications for Home Health Services
• Section 354.1037: Written Plan of Care
• Section 354.1039: Benefits and Limitations of Home Health Services
• Section 354.1040: Requirements for Wheeled Mobility Systems
• Section 354.1042: Supplies Provided by a Pharmacy
• Section 354.1043: Competitive Procurement of Durable Medical Equipment (DME) and Supplies

Division 1: Participation

• Section 354.1801: Requirements for Participation
• Section 354.1803: Confidentiality
• Section 354.1805: Nondiscrimination
• Section 354.1807: Access to Records
• Section 354.1809: Denial or Termination of Participation
• Section 354.1811: Sanctions
• Section 354.1813: Placing a Pharmacy Provider on Vendor Hold

Division 2: Administration

• Section 354.1831: Covered Drugs
• Section 354.1832: Prior Authorization Procedures
• Section 354.1833: Pharmacy Services
• Section 354.1835: Prescriber Identification Numbers
• Section 354.1837: Evidence of Eligibility

Division 3: Medications

• Section 354.1851: Substitution of One Drug for Another in a Prescription
• Section 354.1853: Specialty Drugs

Division 4: Limitations

• Section 354.1861: Availability of Funds
• Section 354.1863: Prescription Requirements
• Section 354.1867: Refills
• Section 354.1868: Exceptions in Disasters
• Section 354.1871: Advertising
• Section 354.1875: Limitations on Provider Charges to Recipients
• Section 354.1877: Quantity Limitations

Division 5: Audits

• Section 354.1891: Vendor Drug Providers Subject to Audit
• Section 354.1892: Exception Notification

Division 6: Pharmacy Claims

• Section 354.1901: Pharmacy Claims
• Section 354.1905: Claim Adjustments
• Section 354.1907: Unacknowledged Claims
• Section 354.1909: Submittal of Special Claims
• Section 354.1911: Electronic Data Transmission Vendors (Switches)

Division 7: Texas Drug Code Index--Additions, Retentions, And Deletions

• Section 354.1921: Addition of Drugs to the Texas Drug Code Index
• Section 354.1923: Review and Evaluation
• Section 354.1924: Preferred Drug List
• Section 354.1925: Resubmittal of a Denied Request
• Section 354.1927: Retention and Deletion of Drugs

Division 8: Drug Utilization Review Board

• Section 354.1941: Drug Utilization Review Board
• Section 354.1942: Conflict of Interest Policy

Division 5: General Administration

• Section 355.8085: Reimbursement Methodology For Physicians And Other Practitioners

Division 28: Pharmacy Services: Reimbursement

• Section 355.8541: Legend and Nonlegend Medications
• Section 355.8542: Drug Price Effective Date
• Section 355.8543: Nonlegend Drug Restrictions
• Section 355.8544: Usual and Customary Prices
• Section 355.8546: Brand-Name Drugs
• Section 355.8547: Reimbursement for Compound Prescriptions
• Section 355.8548: 340B Covered Entities
• Section 355.8549: Reimbursement to Hospitals and Physicians Who Dispense Drugs
• Section 355.8550: Third-Party Resources
• Section 355.8551: Professional Dispensing Fee