Texas HB4533 amends Medicaid and child health plan reimbursement rules for prescription drugs.

Texas HB4533 modifies the reimbursement methodology for prescription drugs under Medicaid and the child health plan program. It mandates that reimbursements to pharmacies be based on either the professional dispensing costs of Texas retail or specialty pharmacies. The bill also requires the executive commissioner to conduct a study of pharmacy dispensing costs every two years and adjust reimbursements accordingly. Additionally, it allows the executive commissioner to require pharmacies to submit cost data as a condition of Medicaid participation. The changes take effect March 1, 2026.

Texas HB4533 amends Medicaid and child health plan reimbursement rules for prescription drugs.

Texas HB4533 modifies the reimbursement methodology for prescription drugs under Medicaid and the child health plan program. It mandates that reimbursements to pharmacies be based on either the professional dispensing costs of Texas retail or specialty pharmacies. The bill also requires the executive commissioner to conduct a study of pharmacy dispensing costs every two years and adjust reimbursements accordingly. Additionally, it allows the executive commissioner to require pharmacies to submit cost data as a condition of Medicaid participation. The changes take effect March 1, 2026.