Sec. 1369.453. APPLICABILITY TO CERTAIN MEDICATIONS. This subchapter applies with respect to only a medication that:
(1) is covered by the enrollee's health benefit plan;
(2) meets the prior authorization criteria specifically applicable to the medication under the health benefit plan on the date the request for synchronization is made;
(3) is used for treatment and management of a chronic illness, as that term is defined by Section 1369.456;
(4) may be prescribed with refills;
(5) is a formulation that can be effectively dispensed in accordance with the medication synchronization plan described by Section 1369.456; and
(6) is not, according to the schedules established by the commissioner of the Department of State Health Services under Chapter 481, Health and Safety Code:
(A) a Schedule II controlled substance; or
(B) a Schedule III controlled substance containing hydrocodone.
Added by Acts 2017, 85th Leg., R.S., Ch. 1007 (H.B. 1296), Sec. 1, eff. September 1, 2017.
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 J. Coverage Related to Prescription Drug Synchronization
Section 1369.452. Applicability of Subchapter
Section 1369.453. Applicability to Certain Medications
Section 1369.454. Proration of Cost-Sharing Amount Required
Section 1369.455. Proration of Dispensing Fee Prohibited
Section 1369.456. Implementation of Certain Medication Synchronization Plans