{"data":{"id":"us-tx/tex.-government-code-540.0273","jurisdiction":"us-tx","citation":"Tex. Government Code § 540.0273","heading":"OUTPATIENT PHARMACY BENEFIT PLAN.","body":"(a) Subject to Subsection (b), a contract to which this subchapter applies must require the contracting Medicaid managed care organization to develop, implement, and maintain an outpatient pharmacy benefit plan for the organization's enrolled recipients that:\n(1) except as provided by Section 540.0280(2), exclusively employs the vendor drug program formulary and preserves this state's ability to reduce Medicaid fraud, waste, and abuse;\n(2) adheres to the applicable preferred drug list the commission adopts under Subchapter E, Chapter 549;\n(3) except as provided by Section 540.0280(1), includes the prior authorization procedures and requirements prescribed by or implemented under Sections 549.0257(a) and (c) and 549.0259 for the vendor drug program;\n(4) does not require a clinical, nonpreferred, or other prior authorization for any antiretroviral drug, as defined by Section 549.0252, or a step therapy or other protocol, that could restrict or delay the dispensing of the drug except to minimize fraud, waste, or abuse; and\n(5) does not require prior authorization for a nonpreferred antipsychotic drug prescribed to an adult recipient if the requirements of Section 549.0253(a) are met.\n(b) The requirements imposed by Subsections (a)(1)-(3) do not apply, and may not be enforced, on and after August 31, 2033.\nAdded by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.\nAmended by:\nActs 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620), Sec. 8.031(a), eff. September 1, 2025.","path":["GOVERNMENT CODE","TITLE 4. EXECUTIVE BRANCH","SUBTITLE I. HEALTH AND HUMAN SERVICES","CHAPTER 540. MEDICAID MANAGED CARE PROGRAM","SUBCHAPTER F. REQUIRED CONTRACT PROVISIONS"],"source_url":"https://statutes.capitol.texas.gov/Docs/GV/htm/GV.540.htm#540.0273","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:16Z","sha256":"3f416342b5ba86720e001ee06cae1ee313c031d662fafd205f5dfda384f0534d","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-government-code-540.02721","next":"us-tx/tex.-government-code-540.0274"},"notice":"GroundRules: Original legal text. Not legal advice."}