Sec. 1369.353. CRITERIA FOR DRUGS ON MAXIMUM ALLOWABLE COST LISTS. A health benefit plan issuer or pharmacy benefit manager may not include a drug on a maximum allowable cost list unless:
(1) the drug:
(A) has an "A" or "B" rating in the most recent version of the United States Food and Drug Administration's Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book; or
(B) is rated "NR" or "NA" or has a similar rating by a nationally recognized reference; and
(2) the drug is:
(A) generally available for purchase by pharmacists and pharmacies in this state from a national or regional wholesaler; and
(B) not obsolete.
Added by Acts 2015, 84th Leg., R.S., Ch. 596 (S.B. 332), Sec. 1, eff. January 1, 2016.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle E - Benefits Payable Under Health Coverages
Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services
Subchapter H. Maximum Allowable Cost
Section 1369.352. Certain Benefits Excluded
Section 1369.353. Criteria for Drugs on Maximum Allowable Cost Lists
Section 1369.354. Formulation of Maximum Allowable Costs; Disclosures
Section 1369.356. Access to Maximum Allowable Cost Lists
Section 1369.357. Appeal From Maximum Allowable Cost Price Determination
Section 1369.358. Confidentiality of Maximum Allowable Cost List
Section 1369.359. Waiver Prohibited