Specialty Drug List

Specialty Drugs

HHSC defines a specialty drug as one that meets all four of the criteria of the “Specialty Drug” rule (1 TAC Section 354.1853). The specialty drug list (SDL) identifies all drugs that meet these criteria. The SDL is published quarterly by the Texas Vendor Drug Program.

Information for pharmacies

  • Any pharmacy can dispense a drug identified on the SDL for people enrolled in traditional Medicaid
  • A pharmacy may need to enroll in a managed care health plan’s specialty pharmacy network to dispense a drug identified on the SDL

Information for Medicaid managed care health plans

  • Texas Government Code section 533.005 ("Required Contract Provisions"; (a)(23)(G)), as added by Section 1.02(d), Senate Bill 7, 82nd Legislature, First Called Session, 2011, requires Medicaid managed care organizations and subcontracted pharmacy benefit managers 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
  • The only drugs that may be exclusively provided through the health plan’s specialty pharmacy network are the drugs listed on the SDL
  • Health plans will have three months after a drug is removed from the final published SDL to adjust contracts as necessary

Information for prescribing providers

  • Prescribing providers may be asked to send prescriptions for drugs on the SDL to a health plan’s specialty pharmacy network
  • Some of the drugs identified on the SDL may also require clinical and/or non-preferred prior authorization

Specialty Drug List

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