Are there any restrictions or limitations on the use of managed care programs to obtain prescription drugs?

Yes, there are restrictions and limitations on the use of managed care programs to obtain prescription drugs in Texas. These restrictions are set out in the Texas Health and Safety Code, Chapter 551. Specifically, managed care programs are not allowed to provide coverage for certain prescription drugs. Such drugs would include controlled substances, drugs not approved by the US Food and Drug Administration, experimental drugs, and compounded drugs. Furthermore, managed care programs are also required to follow certain guidelines when determining coverage for medication, such as providing coverage only for medications that are medically necessary, and providing coverage only for medications that are prescribed by a licensed practitioner. Additionally, managed care programs cannot charge a co-payment rate that is higher than the amount that is set out in the Discounted Price Agreement between the plan and the pharmacy. Finally, managed care programs are required to provide coverage for a 30-day supply of a drug, and only for a limited number of refills. In summary, there are several restrictions and limitations on the use of managed care programs to obtain prescription drugs in Texas. It is important for people to understand these restrictions and limitations in order to ensure that they are receiving the most appropriate and cost-effective coverage.

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Are there any restrictions or limitations on the use of managed care programs to obtain prescription drugs?

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