1 Tex. Admin. Code § 355.8541 - Legend and Nonlegend Medications
(a)
Legend and nonlegend drug reimbursement. A pharmaceutical provider is
reimbursed for legend and nonlegend drugs based on the lesser of the:
(1) acquisition cost (AC) plus the Health and
Human Services Commission's (HHSC's) currently established professional
dispensing fee per prescription;
(2) usual and customary price charged the
general public; or
(3) Gross Amount
Due, if provided.
(b)
AC. The AC is verifiable by invoice audit conducted by HHSC to include
necessary supporting documentation that will verify the final cost to the
provider.
(c) Public hearing.
Notice of a public hearing to receive comments on proposed changes to general
pricing determinations derived under this section will be published in the
Texas Register.
(d) Definitions. The terms used in this
section have the meanings as defined for the same terms in §
354.1921(g) of
this title (relating to Addition of Drugs to the Texas Drug Code
Index).
Notes
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