Texas Register, Volume 1, Number 68, Pages 2393-2438, August 31, 1976 Page: 2,398
This periodical is part of the collection entitled: Texas Register and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
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2398
.001. [Prescriptionl Legend and Non-Legend
Medication. For all medication, legend and non-
legend, covered by the Vendor Drug Program and
appearing in the Texas Drug Code Index and supple-
ments: IFor prescription legend medication except in-
sulin, non-legend drugs, and birth control tablets:]
(a) Reimbursement to the pharmaceutical pro-
vider [pharmacies) will be based upon acquisition cost,
verifiable by invoice audit, plus the department's
currently established dispensing fee [plus a variable
dispensing fee up to a maximum of $2.36] per prescrip-
tion, or the usual and customary Itotal] price charged
non-welfare customers, whichever is lower.
(b) Acquisition cost is defined as wholesale
estimated acquisition cost (WEAC) or direct esti-
mated acquisition cost (DEAC), as shown in the cur-
rent Red Book or supplement, for the drug dispensed
in the pharmacist's usual purchasing quantity, or
maximum allowable cost (MAC) as published by the
Department of Health, Education, and Welfare for
selected multi-source products. Drugs not listed in
the Red Book but listed in the Texas Drug Code In-
dex are to be claimed at invoice cost. [Acquisition
cost is defined as the average wholesale price listed in
the latest edition of the Red Book and supplements for
the drug dispensed in the pharmacist's usual purchas-
ing quantity.] The Texas Drug Code Index [used] will
be used as the reference for allowable package sizes
of purchased drugs. [for the package size in which the
drug was purchased. In the absence of a Red Book
AWP listing of a covered drug, the customary wholesale
markup will be computed, and this price will be used as
the acquisition cost based on the package size used.] No
acquisition cost will be paid for samples dispensed.
(c) Non-legend drugs will be reimbursed on
the basis of the usual charges to the non-welfare
customers or acquisition cost plus 50 percent of cost,
whichever is lower. No dispensing fee will be added
to these items nor may the 50 percent of cost exceed
the provider's assigned variable fee.
(d) The department's variable dispensing fee
is established for each pharmaceutical provider
based upon cost accounting principles and service
expense evaluation studies relating to the total cost
incurred during the preparation and dispensing of
prescriptions. Therefore, the amount paid by the
department for dispensing costs may vary depen-
dent upon the quality and quantity of services pro-
vided recipients. Those providers electing to pro-
vide a full range of pharmaceutical services will be
eligible for reimbursement up to the maximum
allowable rate.The maximum allowable rate would include ex-
penses associated with:
(1) 24-hour emergency services,
(2) patient profiles,
(3) delivery services,
(4) annual participation of staff phar-
macists in continuing education, and
(5) maintaining a comprehensive and cur-
rent pharmaceutical reference library.
(e) [(b)1 Reimbursement to licensed physicians
who dispense their own drugs and to [non-tax-sup-
ported] hospitals with out-patient pharmacies will be
based on actual [direct or wholesale] invoice cost, plus
a dispensing fee as assigned by the department or
usual and customary charge to non-welfare
customers, [whichever is lower, plus a maximum dis-
pensing fee of $1.17 per prescription or usual and
customary total price,] whichever is lower.
.005. Hospitals, Nursing Homes, and Governmental
Institutions.
(a) Rule 326.40.08.004 does [Rules
326.40.08.001-.004 do] not apply to payments for non-
legend drugs (OTC) in hospitals, nursing facilities
[homes], and other institutions where those drugs are
included in the reimbursement formula and vendor
payment to the institution.
(b) If payment is made to government institu-
tions, including tax-supported hospitals, etc., they will
be reimbur:sed on the basis of actual invoice cost
(verifiable by audit) plus an assigned fee for medica-
tions dispensed to eligible recipients. This will be by
agreement between the institution and the Texas
Department of Public Welfare.
.006. Brand Name Drugs.
(a) Physicians specifying a brand name drug
instead of a drug with a maximum allowable cost
are to write, in their own hand, "Brand Necessary"
on the face of the prescription. This enables pay-
ment at the brand name drug estimated acquisition
cost. To indicate this certification (override) on the
Pharmacy Claim, enter "666" in the first three
spaces of the Physician's ID field.
Issued in Austin, Texas, on August 24, 1976.Doc. No. 764500
Raymond W. Vowell
Commissioner
State Department of Public
WelfareEffective Date: August 26, 1976
Expiration Date: December 23, 1976
For further Information, please call (512) 475-4601.Volume 1, Number 68, August 31, 1976
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Texas. Secretary of State. Texas Register, Volume 1, Number 68, Pages 2393-2438, August 31, 1976, periodical, August 31, 1976; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth252847/m1/6/?q=%22%22~1: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.