Applicability To Certain Medications

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.