|(a) The Health and Human Services Commissions (HHSC)
will develop, maintain, and publish a list of specialty drugs on the
Texas Medicaid Vendor Drug Program website.
(b) HHSC will include a drug on the specialty drug
list if HHSC determines that the drug meets all of the following criteria:
(1) The drug is used to treat and is prescribed for
a person with a complex, chronic, or rare medical condition that is
progressive, can be debilitating or fatal if left untreated or undertreated,
or for which there is no known cure. Examples of such conditions include
multiple sclerosis, cystic fibrosis, hemophilia, and rheumatoid arthritis.
(2) The drug is not routinely stocked at a majority
of community retail pharmacies.
(3) The drug has special handling, storage, inventory,
or distribution requirements.
(4) Patients receiving the drug require complex education
and treatment maintenance, such as complex dosing, intensive monitoring,
or clinical oversight.