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Texas Medicaid
Pharmacy Services

Supported by Gainwell Pharmacy Services.

Prescriber Survey Opportunity Due April 30: Texas Prescription Drug Monitoring Program

The annual Centers for Medicare and Medicaid Services (CMS) Drug Utilization Review Survey contains a new, required section of responses related to the Texas Prescription Drug Monitoring Program (PDMP). This year's survey is for data material from Federal Fiscal Year 2023 (Oct. 1, 2022, to Sept. 30, 2023).

CMS now requires Medicaid to report data about prescribing providers' use of PDMPs before prescribing controlled substances. Texas Medicaid obtains this information from the Texas State Board of Pharmacy but does not have access to the PDMP data. A voluntary provider survey created by HHSC will assist HHSC in gathering the required data needed to report on Texas's PDMP usage and meet federal reporting requirements.

HHSC is disseminating the CMS DUR Annual Survey–Provider PDMP Survey for prescribers across multiple platforms and will collect and analyze the responses.

HHSC requests prescribing providers to participate in the survey by April 30, 2024.
 

Published on
April 19, 2024



VDP Provider Portal Training Sessions Now Available; Register for Learning Management System
 
Gainwell Technologies presented VDP Provider Portal training sessions during the week of March 12-19, 2024. A recording of the session is now available in the Gainwell Learning Management System (LMS).

For VDP Provider Portal Training:
  1. Each person will need to register for VDP Provider Portal Training: mmislearningcenter.myabsorb.com. This link directs you to the Gainwell Learning Management System (LMS) where you can enroll for the session. 
  2. You will need a specific enrollment key to register. Please email BaselineMedicaidTraining@gainwelltechnologies.com for the enrollment key. In the email, please include your name, company name, and National Provider Identifier (NPI). An enrollment key may take up to two business days.
  3. After you receive your enrollment key, return to the LMS to create a password that contains at least one letter, one number, and at least eight characters in length.
  4. Once registered, use the catalog search feature to locate and enroll in “provider portal training" course.
The VDP Provider Portal is intended:
For prescribers, to perform the following activities: 
  • Submit clinical and non-preferred prior authorization requests
  • Check the status of prior authorization requests
  • Send secure messages and chat
  • View portal user training
For pharmacies, to perform the following activities: 
  • Access weekly Electronic Remittance Advice/835 payment files
  • Check client eligibility
  • Check claim status
  • Receive pharmacy-specific notifications
  • View portal user training 
For more information, please refer to the VDP Provider Portal Registration Manual. TX VDP Provider Portal – Registration User Guide

Updated: April 17, 2024
Published: April 1, 2024​ 

Reminder to Pharmacies to Register for their 835 Electronic Remittance Advice on the New VDP Provider Portal 

The Texas Vendor Drug Program (VDP) requires all pharmacy providers to register for the new VDP Provider Portal to receive their 835 Electronic Remittance Advice. The 835 Electronic Remittance Payment Advice allows the automated matchup of claims payment data sent to the receiver from VDP using computer software.  
People attempting to register for the VDP Provider Portal should collect the following pieces of information before beginning the registration process: 
  • 10-digit National Pro​vider Identifier (NPI) 
  • 6-digit Personal Identification Number (PIN) 
  • 9-digit Federal Employer Identification Number (FEIN) 
You should ensure you've entered all three numbers correctly. Refer to the VDP Provider Portal Registration User Guide for details how to register or the 835 Companion Guide for technical information on 835 ERAs. To register for access, do the following: 
  1. On the top of this portal home page, click Register. 
  2. Complete the demographic, user details, and confirm information and agreement sections. 
  3. You will receive an email to activate your account.  
  4. Complete the activation steps.  
​Registration Support: 
If you have not received the 835 Electronic Remittance Payment Advice, contact the Gainwell Pharmacy and Technical Call Center at 800-435-4165, Monday to Friday, from 7 a.m. to 7 p.m. 
 
​Published: April 5, 2024 ​


Agenda for April Drug Utilization Review Board Meeting Now Available

The Texas Drug Utilization Review Board agenda for Friday, April 26, 2024, is now available. Refer to the Texas Drug Utilization Review Board Handbook for the instructions about submitting written materials to the board before the meeting and public testifying on the day of the meeting.

People providing written or public testimony must complete the appropriate testimony form in addition to the Public Comment Registration form linked on the agenda.

 

Published: April 12, 2024



Texas VDP Provider Portal for Pharmacies and ​Prescribers​

Gainwell Technologies launched an online VDP Provider Portal beginning on March 31, 2024.  

The purpose of the VDP Provider Portal is to:
  • Access Electronic Remittance Advices and 835 for weekly payments.​​​​
  • Check the status of prior authorizations submitted by prescribers.
  • Read general pharmacy announcements.
  • Receive pharmacy-specific notifications. 

Beginning March 15, 2024, Gainwell notified pharmacies and prescribers by USPS with the portal link and credentials. ​







HHSC Published the Pharmacy Payer Sheets - Beginning March 30, 2024

On Jan. 31 , HHSC published the pharmacy payer sheets for use beginning March 30, 2024. An update is now available

Pharmacy staff should continue using the current payer sheets for all fee-for-service Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, Kidney Health Care (KHC), and Healthy Texas Women (HTW) claims between now and March 30. Refer to the Pharmacy Provider Procedure Manual for the current Bank Identification Number (BIN), Processor Control Number (PCN), and Group ID values for the above programs.

Refer to the System Transition Resources for more information about this change. You can also register with the HHSC email notification service to review emails from VDP about the change. ​



​Updated Drug Shortage Notification and Expedited Preferred Drug List Form Available

Pharmacies and other stakeholders can use the revised Drug Shortage Notification and Expedited Formulary or Preferred Drug List Request (HHS Form 1315) to submit the following requests to the Vendor Drug Program:

  • potential drug shortages impacting prescribing choice and pharmacy claims processing;
  • requests for addition of drugs to the VDP formulary; or
  • requests for changes to the preferred drug list

VDP will respond to the requestor within 24 hours on reported drug shortages.

Updates to this form comply with Texas Government Code, Section 531.072(g) as added by H.B. 3286, 88th Texas Legislature.

Published on March 27, 2024



Summary of Jan. 2024 Drug Utilization Review Board Meeting Now Available

The Texas Drug Utilization Review Board met Friday, Jan. 26, 2024, to recommend clinical prior authorizations and drugs on the Texas Medicaid Preferred Drug List. Available online are:

  • A recording of this meeting's webcast
  • A report of this quarter's clinical prior authorization and PDL recommendations
  • Approved minutes from the Thursday, Oct. 12, and Friday, Oct. 13, 2023, meetings
  • The PDL drug class review schedule for the Friday, April 26 meeting

Clinical Prior Authorization Updates
Clinical prior authorizations may implement for traditional Medicaid and managed care at any time:

  • Providers and stakeholders will be notified once an implementation date has been set for traditional Medicaid.
  • Refer to MCO Search for a link to each MCO's clinical prior authorization page.
  • The Pharmacy Clinical Prior Authorization Assistance Chart identifies which prior authorizations are utilized by each MCO and how those relate to those used by HHSC.

 Presented:

Approved as presented:

Not approved as presented:

Preferred Drug List Updates
Preferred drugs are medications recommended by the board for their efficaciousness, clinical significance, safety, and cost effectiveness. PDL recommendations are pending until the final decision is released by the Texas HHS executive commissioner. HHSC will incorporate the approved decisions from the Oct. 2023 board meetings into the Jan. 2024 PDL. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

The Oct. 2023 PDL recommendations are available. Notable changes include:

PDL ClassDrugCurrent PDL StatusRecommended Status
Acne Agents, TopicalAdapalene gel OTC (topical)Non-PreferredPreferred
Acne Agents, TopicalCabtreo gel (topical)Non-ReviewedPreferred
Acne Agents, TopicalZMA Clear Cleanser (topical)Non-ReviewedPreferred
Analgestics, Narcotics LongTramadol ER (Ryzolt) (oral)PreferredNon-Preferred
Bladder Relaxant PreparationsVesicare (oral)PreferredNon-Preferred
Glucagon AgentsGvoke Pen (subcutaneous)PreferredNon-Preferred
Glucagon AgentsZegalogue Autoinjector (subcutaneous)Non-PreferredPreferred
Movement Disorders

Austedo XR (oral)

Austedo XR (oral)

Non-ReviewedPreferred
Movement DisordersTetrabenazine (oral)Non-PreferredPreferred
Movement DisordersXenazine (oral)PreferredNon-Preferred
Neuropathic PainDermacinrx Lidocan patch (topical)Non-ReviewedNon-Preferred
Neuropathic Pain

Lidocaine (AG) (topical)

Lidocaine (topical)

Non-ReviewedPreferred
Neuropathic PainLidocan II (topical)Non-ReviewedNon-Preferred
Neuropathic PainXyliderm (topical)Non-ReviewedNon-Preferred
Oncology, Oral – LungAugtyro capsule (oral)Non-ReviewedPreferred
Oncology, Oral – LungRozlytrek pellet pack (oral)Non-ReviewedPreferred
Oncology, Oral – LungXalkori pellet (oral)Non-ReviewedPreferred
PAH Agents, oral and inhaledLiqrev Suspension (oral)Non-ReviewedNon-Preferred
PAH Agents, oral and inhaledOrenitram Titration Kit (oral)Non-ReviewedNon-Preferred
Phosphate BindersXphozah tablet (oral)Non-ReviewedNon-Preferred
Stimulants and Related AgentsQelbree (oral)Non-PreferredPreferred
Stimulants and Related AgentsRelexxii (oral)Non-ReviewedNon-Preferred
AnticonvulsantsMotpoly XR (oral)Not ReviewedPreferred
Opiate Dependence TreatmentsNarcan Spray OTC (Nasal)Not ReviewedPreferred
AntipsychoticsRykindo (intramusc)Not ReviewedNon-Preferred
Cytokine and CAM AntagonistsAdalimumab-Adbm Kit (Injection) (Cf) 50 Mg/MlNot ReviewedNon-Preferred
Cytokine and CAM AntagonistsAdalimumab-Adbm Pen Kit (Injection) (Cf) 50 Mg/MlNot ReviewedNon-Preferred
Cytokine and CAM AntagonistsEntyvio Pen (Subcutane)Not ReviewedNon-Preferred
Erythropoiesis Stimulating ProteinsJesduvroq Tablet (oral)Not ReviewedNon-Preferred
Glucocorticoids, InhaledAirsupra Hfa (Inhalation)Not ReviewedNon-Preferred

About the Texas DUR Board
Board members meet quarterly in Austin to make recommendations about outpatient prescription drugs in the Medicaid program. The schedule of upcoming meetings, instructions on how to submit written materials to the board, and directions about publicly testifying before the board are available on the VDP website.

Published on February 9, 2024​
 



IMPORTANT: Portal Registration Reminder

Please collect the following three pieces of information before beginning the registration process:

  • 10-digit National Provider Identifier Number (NPI)
  • 6-digit Personal Identification Number (PIN)
  • 9-digit Federal Employer Identification Number (FEIN) 

Please ensure you've entered all three numbers correctly. Refer to the VDP Provider Portal Registration User Guide for more information.​



Register for the Texas VDP Provider Portal

The VDP Provider Portal is active, and we recommend the appropriate pharmacy and prescriber staff register for it. 

Credentials Needed:
Before you start, please gather the following three pieces of information: 

  • 10-digit National Provider Identifier Number (NPI)
  • 6-digit Personal Identification Number (PIN)
  • 9-digit Federal Employer Identification Number (FEIN) 

***IMPORTANT: Please set aside about 10 minutes to complete your registration. You cannot save your progress and return to it later.*** 

Step 1: On the top of this portal home page, click Register.
Step 2: Complete the demographic, user details, and confirm information and agreement sections. 
Step 3: You will receive an email to activate your account.
Step 4: Complete the activation steps.  
 
Registration Support:
If you need help with registration, please call the Pharmacy and Technical Call Center at 800-435-4165, ​​during r
egular operating hours of Monday to Friday, 7 a.m. to 7 p.m. 



​Gainwell System Transition Resources

On Saturday, March 30, 2024, Gainwell Technologies became the pharmacy benefits administrator for the Texas Vendor Drug Program. The below system information will assist pharmacies, manufacturers, and prescribers. All times are central time zone.

Claims System 

  • Gainwell:
    • Began processing claims at 12:00 a.m. on Sunday, March 31
Field NumberField NameMedicaid, CSHCNKHC
101-A1Bank Identification Number (BIN)025417025417
104-A4Processor Control NumberDRTXPRODDRTXPRODKH
301-C1Group ID

MEDICAID

CSHCN

KHC

VDP Provider Portal

  • provider.txvdpportal.com
  • Gainwell:
    • Began operations at 12:00 a.m. on Sunday, March 31. 
      • For questions call the Pharmacy and Technical Call Center:
          • 800-435-4165

Prior Authorization

  • Current:
    • Texas Pharmacy Prior Authorization Call Center:
      • Will accept faxed prior authorization requests until 3:00 p.m. on Friday, March 29
      • Closes at the usual time, 6:30 p.m. on Friday, March 29
      • Automated prior authorizations will continue until the current system shuts around 11:59 p.m., Friday, March 29,
  • Gainwell:
    • Texas Pharmacy Prior Authorization Call Center:
      • Began accepting prior authorization requests at 12:00 a.m. on Sunday, March 31:
        • 877-PA-TEXAS (877-728-3927)
      • Will again accept faxes beginning at 8:00 a.m. on Saturday, March 30:
        • 866-469-8590

Rebate Inquiries

  • Current:
    • Shut down at 11:59 p.m. on Friday, March 29
  • Gainwell:
    • Begins accepting inquiries, Reconciliation of State Invoice (ROSI) and Prior Quarter Adjustment Statement (PQRS) documentation, and claims-level detail requests on Monday, April 1,
      • Email: TXDrugRebate@gainwelltechnologies.com​

Updated: March 31, 7:05 a.m.

Published on March 27, 2024​


  • General
  • Provider
Welcome to Texas Medicaid Pharmacy Services Online Portal
Sample Image
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.
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.