March 2018 Specialty Drug List

Specialty Drugs

Texas Government Code §533.005(a)(23)(G), as added by Section 1.02(d), Senate Bill 7, 82nd Legislature, First Called Session, 2011, requires Medicaid managed care organizations (MCO) and subcontracted pharmacy benefit managers (PBM) to adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that are consistent with rules adopted by the Executive Commissioner. The only drugs that may be exclusively provided through the MCO’s specialty pharmacy network are the drugs listed on this specialty drug list. The list was developed by HHSC and follows the criteria set forth in the specialty drug rule (1 TAC §354.1853).

Only drugs that may be exclusively provided through the MCO's specialty pharmacy network are listed on the specialty drug list. This list includes drugs that are on the Medicaid Formulary or provided as Medicaid medical benefit.

Specialty Drug List