Texas § GV.540.0901 - PREFERRED DRUG LIST EXCEPTIONS

§ GV.540.0901. PREFERRED DRUG LIST EXCEPTIONS

PREFERRED DRUG LIST EXCEPTIONS. (a) The commission shall adopt rules allowing exceptions to the preferred drug list if: (1) the drug required under the preferred drug list: (A) is contraindicated; (B) will likely cause an adverse reaction in or physical or mental harm to the recipient; or (C) is expected to be ineffective based on the known clinical characteristics of the recipient and the known characteristics of the prescription drug regimen; (2) the recipient previously discontinued taking the preferred drug at any point in the recipient's clinical history and for any length of time because the drug: (A) was not effective; (B) had a diminished effect; or (C) resulted in an adverse event; (3) the recipient was prescribed and is taking a nonpreferred drug in the antidepressant or antipsychotic drug class and the recipient: (A) was prescribed the nonpreferred drug before being discharged from an inpatient facility; (B) is stable on the nonpreferred drug; and (C) is at risk of experiencing complications from switching from the nonpreferred drug to another drug; or (4) the preferred drug is not available for reasons outside of the Medicaid managed care organization's control, including because: (A) the drug is in short supply according to the Food and Drug Administration Drug Shortages Database; or (B) the drug's manufacturer has placed the drug on backorder or allocation. (b) An exception provided under this section does not subject the Medicaid managed care plan to liquidated damages for failing to comply with the preferred drug list. Added by Acts 2023, 88th Leg., R.S., Ch. 739 (H.B. 3286 ), Sec. 2, eff. September 1, 2023. Transferred and redesignated from Government Code, Subchapter C, Chapter 533 by Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620 ), Sec. 8.033, eff. September 1, 2025.