|(a) To participate in a health care MCO's network,
a pharmacy provider must be licensed with the Texas State Board of
Pharmacy, have a national provider identifier, and be enrolled as
a Medicaid provider with HHSC. To provide services to a member of
a MCO when the member is located in another state, the pharmacy provider
must be licensed with the pharmacy licensing entity in that state,
have a national provider identifier, and be enrolled as a Medicaid
provider with HHSC.
(b) A pharmacy provider is subject to the Vendor Drug
Program rules in Chapter 354, Subchapter F, Division 1 and Division
5 of this title (relating to Participation; and Audits).
(c) The prescription requirements in §354.1863(a),
(b), and (d) of this title (relating to Prescription Requirements)
apply to all pharmacy providers.
(d) Except as prohibited by the health care MCO, a
pharmacy provider may substitute one covered outpatient drug for another
covered outpatient drug in a prescription only if authorized by the
prescribing physician in accordance with 22 TAC §309.3 (relating
to Generic Substitution).