{"data":{"id":"us-tx/tex.-government-code-540.0277","jurisdiction":"us-tx","citation":"Tex. Government Code § 540.0277","heading":"PHARMACY BENEFIT PLAN: PHARMACY BENEFIT PROVIDERS.","body":"(a) A Medicaid managed care organization's pharmacy benefit plan required by Section 540.0273 in a contract to which this subchapter applies must allow the organization or any subcontracted pharmacy benefit manager to contract with a pharmacist or pharmacy providers separately for specialty pharmacy services, except that:\n(1) the organization and pharmacy benefit manager are prohibited from allowing exclusive contracts with a specialty pharmacy owned wholly or partly by the pharmacy benefit manager responsible for administering the pharmacy benefit program; and\n(2) the organization and pharmacy benefit manager must adopt policies and procedures for reclassifying prescription drugs from retail to specialty drugs that:\n(A) are consistent with rules the executive commissioner adopts; and\n(B) include notice to network pharmacy providers from the organization.\n(b) A Medicaid managed care organization, under the organization's pharmacy benefit plan required by Section 540.0273 in a contract to which this subchapter applies:\n(1) may not prevent a pharmacy or pharmacist from participating as a provider if the pharmacy or pharmacist agrees to comply with the financial terms, as well as other reasonable administrative and professional terms, of the contract;\n(2) may include mail-order pharmacies in the organization's networks, but may not require enrolled recipients to use those pharmacies; and\n(3) may not charge an enrolled recipient who opts to use a mail-order pharmacy a fee, including a postage or handling fee.\nAdded by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 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#540.0277","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:16Z","sha256":"c5f47bc41445541363c8f584e8b8e5e5fe490a935892a3d36fc0de6bdcd453e6","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-government-code-540.0276","next":"us-tx/tex.-government-code-540.0278"},"notice":"GroundRules: Original legal text. Not legal advice."}