System updates will be applied on February 19, 2026 at 6:00 PM. These updates will include changes to the user interface. Work is expected to take approximately 30 minutes to complete, during which the site will be unavailable.
Amend CSSB 1 (house committee printing) in Article II of the
bill, following the appropriations to the Health and Human Services
Commission, by striking Rider 48 (Physician-administered Biologics
and Drugs Rider, page II-89) and substituting the following:
48. Physician-administered Biologics and Drugs. To the
extent compatible with state and federal law, drugs and biological
products are deemed covered benefits of Medicaid if those products
are approved for sale by the U.S. Food and Drug Administration and
satisfy the criteria of the Omnibus Budget Reconciliation Act of
1990 and the Deficit Reduction Act of 2005. The manufacturers of
drugs and biological products which are deemed covered benefits
under Medicaid shall obtain a unique HCPCS code of C, Q, or J and a
National Drug Code that will enable the state Medicaid office to
track the product for the purpose of receiving Medicaid rebates.
HHSC shall develop and make available a process to analyze
new, "first-in-class," physician-administered drugs and biological
products for the purpose of issuing a Medicaid coverage report or
opinion.
For new physician-administered drugs and biological products
slated for inclusion in an existing class covered by Medicaid, HHSC
shall develop and make available an expedited process to analyze
fiscal impact and incremental cost over current drug treatment and
therapy.
HHSC shall develop and make available a process for approving
new FDA-approved indications of physician-administered drugs and
biological products covered by Medicaid.
HHSC may apply any reasonable administrative measures,
including medical policy development and utilization controls that
it deems prudent as the conditions of coverage that apply to each
physician-administered drug or biological product.