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Texas Medicaid
Pharmacy Services

Supported by Gainwell Pharmacy Services.

Announcements

The Texas Drug Utilization Review Board agenda for Friday, October 23, 2026, is now available. Refer to the Texas Vendor Drug Program website for more information.


Emergency Dispensing of Prescription Medications Related to July 2026 Severe Storms

July 20, 2026

On Tuesday, July 14, Governor Greg Abbott announced a disaster declaration due to heavy rainfall and the risk of flash flooding. The Texas State Board of Pharmacy issued information regarding the emergency dispensing of prescription medications in response on July 16.

Fee-for-Service

HHSC will allow pharmacies to override prescription claims rejected with error code 79 (Refill Too Soon) for individuals enrolled in Medicaid, the Children with Special Health Care Needs Services Program, and the Kidney Health Care Program who are affected by the flooding. Pharmacies should submit the following values in the fields identified in the table below.

Field Number

Field Name

Submitted Value

461-EU

Prior Authorization Type Code

9

462-EV

Prior Auth ID Submitted

3342

 

Managed Care

For people enrolled in Medicaid managed care or CHIP, pharmacies should contact the person's managed care organization for instructions. Refer to the MCO Search for each MCO's contact information and billing codes.

Refer to the Texas Vendor Drug Program website at txvendordrug.com/about/news for more information, or call the Texas Medicaid Pharmacy and Technical Call Center at 800-435-4165, Monday to Friday, 7 a.m. to 7 p.m. (Central Time).


HHSC will add all recommended adult vaccines to the Medicaid formulary as a payable pharmacy benefit beginning June 1, 2026. While adult vaccines were previously only covered under the Medicaid medical benefit, this rollout allows Medicaid to reimburse pharmacies for both the vaccine ingredient and administration costs for adults ages 19 and older. To administer vaccines through the pharmacy benefit, a pharmacy must have an executed Collaborative Practice Agreement (CPA) with a licensed provider serving as a standing order. If there is no CPA, the pharmacy must obtain a patient-specific prescription from the treating clinician before administering the vaccine. Refer to the Vendor Drug Program website for more information.


Starting July 1, 2026, the selection of drugs available to HTW clients will expand to include all Medicaid-eligible drugs within the health care categories covered by HTW. Additionally, HHSC will apply the preferred drug list (PDL) and clinical prior authorizations to formulary drugs in HTW to match the prior authorization applied in the Medicaid program for the same drugs. These changes are a result of HHSC's continued efforts to transition HTW from a state-funded to a Medicaid-funded program and, therefore, are required for inclusion in Medicaid. Federal law requires coverage comparability across all Medicaid programs. Making these changes also ensures consistency for clients and providers across Medicaid. Refer to the Vendor Drug Program website for more information.


The National Council for Prescription Drug Programs (NCPDP) will update its telecommunications standard to version F6 for pharmacy claims transactions in 2028. The current standard is version D.0. This change impacts how pharmacies submit claims to VDP and MCOs. Planning efforts are underway to assess impacts, engage stakeholders, and support a coordinated transition. VDP will share additional guidance and detailed requirements as they become available. VDP offers an optional survey for pharmacy staff to ask questions about the impending change. Refer to the Vendor Drug Program website for more information.


Beginning July 1, 2026, HHSC will require a prescription for dispensing at-home COVID-19 test kits through the outpatient drug benefit for people enrolled in Medicaid and CHIP. The change is due to the end of federal regulation requiring coverage for at-home COVID-19 test kits and applies to fee-for-service and managed care. There are no changes to the maximum limit of four test kits per month. Refer to the Vendor Drug Program website for more information.


  • General
  • Provider
Welcome to Texas Medicaid Pharmacy Services Online Portal
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This website provides information to pharmacies, prescribers, and the public. Users may find helpful website links and documents within our online portal in the menu bar above.
Medicaid News
Providers / Trading Partners
Registered portal users can::

  • Retrieve Remittance Advice
  • Verify Eligibility
  • Submit Prior Authorization
  • View Prior Authorization Status
  • View Claim Status
  • View Claim and Prior Authorization History
  • VDP Provider Portal Registration
  • Pharmacy Billing Information
Beginning March 30, 2024, any provider (prescriber or pharmacy) that elects to use the Portal to exchange PHI will be required to register as a trading partner. Pharmacies and prescribing providers must be enrolled with Texas Medicaid prior to registering as a trading partner. Trading partner account registration/activation enables access to the secure provider portal for direct data entry of claims and prior authorizations, claim status inquiries, member eligibility inquiries, ​and remittance advice​​​
​Claims can be submitted through POS.