1 Tex. Admin. Code § 355.8546 - Brand-Name Drugs

(a) Physicians who want a brand name drug dispensed on a prescription for a multisource drug must handwrite the phrase "Brand necessary" on the face of the prescription. This procedure enables payment for the drug at the more expensive brand name acquisition cost. To indicate this certification (override) on the pharmacy claim form, the pharmacy provider must enter "1" in the field for "Dispense as Written." For telephone orders involving physician overrides, a written prescription must be obtained from the prescribing physician within 30 days from the time the order was placed.

(b) A physician override for a prescription is valid only for the life of the prescription. The life of the prescription is defined as the original dispensing and any authorized refills, not to exceed eleven refills or a twelve-month supply. The physician override cannot be forwarded or transferred to any other prescription for the same drug.

(c) A pharmacy provider that dispenses a brand drug that is subject to a generic reimbursement and bills HHSC for the service must accept Medicaid reimbursement as payment in full. No additional dispensing fee or product cost amounts may be billed to the Medicaid recipient.

Notes

1 Tex. Admin. Code § 355.8546

The provisions of this §355.8546 adopted to be effective November 16, 1987, 12 TexReg 3553; Amended to be effective July 1, 1993, 18 TexReg 1584; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 1997, as published in the Texas Register December 11, 1998, 23 TexReg 12660; Amended to be effective June 9, 2010, 35 TexReg 4661; Amended by Texas Register, Volume 41, Number 19, May 6, 2016, TexReg 3301, eff. 5/15/2016