Texas regulates MAC lists, not reimbursement levels. The maximum allowable cost subchapter of the Insurance Code requires that a drug be listed only if it is a qualifying generic “generally available for purchase” from a Texas wholesaler, and that lists be updated — but it does not require reimbursement at NADAC or above acquisition cost.
Pharmacies get a defined appeal: a MAC price may be appealed on or before the 10th day after the claim, and the PBM must respond by the 10th day after receiving the appeal. On a denial, the PBM must identify an NDC showing where the drug is available at the disputed MAC price.