The proposed amended rule, published in the Texas Register on Feb. 14, allows HHSC, under limited circumstances, to exercise discretion to waive the normal prior authorization requirement for non-preferred drugs.
The Medicaid Vendor Drug Program processes claims for outpatient prescription drugs for Medicaid clients in the fee-for-service program, manages the list of drugs covered by Medicaid (e.g., the formulary), and determines which drugs are designated as preferred and non-preferred. Preferred drugs are placed on the preferred drug list (PDL) and do not require prior authorization. Health care practitioners must request prior authorization for non-preferred drugs. HHSC proposes the amendment to address circumstances when a drug's status is redesignated from preferred to non-preferred, and it may be administratively more efficient to deem the approved prior authorization for a particular client for a certain period of time, or for an indefinite period.
Such a waiver would be subject to certain clinical considerations, including health and safety factors and guidance from the Pharmaceutical and Therapeutics Committee.
The HHSC Council meeting on February 28, 2014, will function as a public hearing to receive public comment on this proposed amendment. The earliest possible date of adoption: March 16, 2014.