Prescription Limits Sample Clauses

Prescription Limits. The MCO must comply with HHSC’s policies concerning prescription limits, including limitations on the numbers of prescriptions per month and day supply limits. Adult Medicaid Members are generally limited to three (3) prescriptions per month. This limitation does not apply to children, and it does not apply to adult Members enrolled in a waiver program for Community-based Long Term Services. STAR MCOs in the Medicaid Rural Service Area must provide unlimited prescriptions to Members who are enrolled in a 1915(c) waiver program. STAR+PLUS MCOs will provide unlimited prescriptions to Members who are qualified for and enrolled in the STAR+PLUS Waiver Program for Community-based Long Term Services and Supports. Medicaid Members who are limited to three (3) prescriptions per month must be able to receive up to a 90-day supply of a drug without additional prior authorization, and up to a 185-day supply with prior authorization. CHIP Members are generally subject to 34-day supply limit. Exceptions can be made for unbreakable packages. Additional information concerning HHSC’s prescription limit policies is available on HHSC’s website at xxxx://xxx.xxxxxxxxxxxx.xxx/index.shtml.
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Related to Prescription Limits

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