Welcome to
Texas Medicaid
Pharmacy Services

Supported by Gainwell Pharmacy Services.

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

The Texas Drug Utilization Review (DUR) Board met on Friday, Oct. 25, 2024, to recommend changes in the Medicaid program to the preferred drug list, clinical prior authorization criteria, and retrospective drug utilization review criteria. Refer to the Vendor Drug Program website for more information.

Published on
November 9, 2024



New Medicaid, CHIP Provisional Formulary Available Beginning Nov. 18, 2024

Beginning Nov. 18, drugs added to the provisional formulary are available for reimbursement at the pharmacy point-of-sale for enrollees in Medicaid managed care, fee-for-service, and the Children's Health Insurance Program. VDP will make the list of these drugs available on the VDP website. Drugs on the provisional list may become unavailable if VDP denies the COI.

Refer to the Vendor Drug Program website for more information.

 
Published on
November 9, 2024​




Veterans Day Holiday to Delay Pharmacy Payments 

There will be a one-day delay in Vendor Drug Program payments to pharmacy providers because of the Veterans Day holiday on Monday, November 11. The delay affects claims for traditional Medicaid, the Children with Special Health Care Needs Services Program, and the Kidney Health Care Program.  
 
HHSC will pay claims submitted between November 1 and November 7 on Tuesday, November 12, with deposits available on November 14. HHSC will pay claims submitted on or after November 12 on the regular cycle.  
 
Refer to the Payment section of the Pharmacy Provider Procedure Manual for more information on payment delays. 
For more information, call the Texas Medicaid Pharmacy and Technical Call Center at 800-435-4165, Monday through Friday from 7 a.m. to 7 p.m. (central time). 
 
Published on   
October 30, 2024  


Revised Pharmacy Payer Specification Manuals Now Available

VDP revised the pharmacy payer specification manuals to address the following:
  • Added value of “9” in field 461-EU
  • Added 462-EV “*When Disaster occurs, number and details will be issued” for NCPDP Claim Billing (B1) Transaction
VDP updated the following manuals with this change:
These manuals include program-specific rules and requirements for claims processing. We recommend you share these manuals with your software and switch vendors to ensure they have the latest version. These and other manuals are available on the VDP Provider Portal.

If you have questions about pharmacy claims processing for the programs above, call the Texas Medicaid Pharmacy and Technical Call Center  at 800-435-4165, Monday to Friday, from 7 a.m. to 7 p.m. Central Time.

Published on
October 29, 2024


Oct. 2024 Specialty Drug List Now Available

The Oct. 2024 biannual Specialty Drug List is now available. 

Refer to the Vendor Drug Program website for more information.

​Published on
October 17, 2024

VDP Provider Portal Registration, Training Reminder for Prescribers
The Texas Vendor Drug Program (VDP) requires all prescribers to register for the  VDP Provider Portal. Prescribers can use the portal to: ​
  • Submit clinical and non-preferred prior authorization requests.  
  • Check the status of prior authorization requests.  
  • View prescriber-specific announcements and receive correspondence.
  • View portal user training.  
  • Send secure messages and chat with the Gainwell Pharmacy and Technical Support Center staff.
Portal Registration
You must submit the following information before you register:
  • Your 10-digit National Provider Identifier (NPI)
  • Your 6-digit Personal Identification Number (PIN)
  • Your 9-digit Federal Employer Identification Number (FEIN)
Refer to the VDP Provider Portal Registration User Guide for all registration instructions.

To register for access, perform the following steps:
  1. On the top of the portal home page, click Register.
  2. Complete the demographic and user details, and confirm the information and agreement sections. After you have completed these sections, an email will be sent to you to activate the account.
  3. Complete the activation steps listed in the email.
Portal Training Sessions
Prescribers can review a recorded portal training session on the Gainwell Learning Management System (LMS).
  • For first-time LMS access, users must request an enrollment key and create a username and password for site registration.
  • First-time LMS users must email baselinemedicaidtraining@gainwelltechnologies.com to request and receive an enrollment key. In the email request, include your name, company name, and NPI. It may take up to two business days to receive the enrollment key.
  • After receiving the enrollment key, access the Gainwell LMS link again to enter the key and select the Sign Up button. Then, complete the required identification fields. Refer to Section 4.1 of the VDP LMS First-time User Guide for more information.
After you register for the LMS, you can use the catalog search feature to find and enroll in the VDP Provider Portal training course.

Support
To request assistance with the portal or LMS, call the Texas Medicaid Pharmacy and Technical Call Center at 800-435-4165, Monday through Friday, from 7 a.m. to 7 p.m. Central Time.

Published on





VDP Provider Portal Registration, Training Reminder for Pharmacies

The Texas Vendor Drug Program (VDP) requires all pharmacies to register for the  VDP Provider Portal. Pharmacies can use the portal to:
  • Access weekly Electronic Remittance Advice/835 payment files
  • Check client eligibility
  • Check claim status
  • View pharmacy-specific announcements and receive correspondence.
  • View portal user training.  
  • Send secure messages and chat with the Gainwell Pharmacy and Technical Support Center staff.
Portal Registration
You must submit the following information before you register:
  • Your 10-digit National Provider Identifier (NPI)
  • Your 6-digit Personal Identification Number (PIN)
  • Your 9-digit Federal Employer Identification Number (FEIN)
Refer to the VDP Provider Portal Registration User Guide for all registration instructions.

To register for access, perform the following steps:
  1. On the top of the portal home page, click Register.
  2. Complete the demographic and user details, and confirm the information and agreement sections. After you have completed these sections, an email will be sent to you to activate the account.
  3. Complete the activation steps listed in the email.
Portal Training Sessions
Pharmacies can review a recorded portal training session on the Gainwell Learning Management System (LMS).
  • For first-time LMS access, users must request an enrollment key and create a username and password for site registration.
  • First-time LMS users must email baselinemedicaidtraining@gainwelltechnologies.com to request and receive an enrollment key. In the email request, include your name, company name, and NPI. It may take up to two business days to receive the enrollment key.
  • After receiving the enrollment key, access the Gainwell LMS link again to enter the key and select the Sign Up button. Then, complete the required identification fields. Refer to Section 4.1 of the VDP LMS First-time User Guide for more information.
After you register for the LMS, you can use the catalog search feature to find and enroll in the VDP Provider Portal training course.

Support
To request assistance with the portal or LMS, call the Texas Medicaid Pharmacy and Technical Call Center at 800-435-4165, Monday through Friday, from 7 a.m. to 7 p.m. Central Time.

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October 2024 NDC-to-HCPCS Crosswalk Available for Clinician-Administered Drug Processing

The quarterly Texas National Drug Codes (NDC) to Healthcare Common Procedure Coding System (HCPCS) Crosswalk is now available for clinician-administered drug processing.

Refer to the Texas Vendor Drug Program website for more information.

Published on 
October 16, 2024​

UPDATE: HHSC To Remove Oxbryta Products From All Formularies As Of Oct. 17, 2024

HHSC will remove the Oxbryta products listed below and any clinical prior authorizations from all formularies as of Oct. 17, 2024. We originally announced we would remove these drugs on Oct. 10.


Published on
October 11, 2024



Columbus Day Holiday to Delay Pharmacy Payments

There will be a one-day delay in Vendor Drug Program payments to pharmacy providers because of the Columbus Day holiday on Monday, October 14. ​The delay affects claims for traditional Medicaid, the Children with Special Health Care Needs Services Program, and the Kidney Health Care Program. 

HHSC will pay claims submitted between October 4 and October 10 on Tuesday, October 15, with deposits available on October 17. HHSC will pay claims submitted on or after October 5 on the regular cycle. 

Refer to the Payment section of the Pharmacy Provider Procedure Manual for more information on payment delays.

Published on  
October 4, 2024 ​



Deadline for H.B. 3286 Draft Policy Review Due Oct. 25, 2024

The HHSC Vendor Drug Program (VDP) accepts stakeholder comments on the revised H.B. 3286-related draft policy. The comment period ends Oct. 25, 2024. Submit your comments using the Draft Policy Comment Submission (HHS Form 1342). VDP will consider the comments in developing the final policy and will share it and implementation date for Medicaid in the future. Refer to the Vendor Drug Program website for more information.

Published on
October 11, 2024




Change in Preferred Drug List Status for Generic Sildenafil Oral Suspension As Of Sept. 25, 2024

VDP removed the non-preferred status from the generic sildenafil oral suspension products on the preferred drug list effective Sept. 25 due to the manufacturer's discontinuation. Refer to the Vendor Drug Program website for more information.
  • ​Originally published on the Vendor Drug Program website on Sept. 27, 2024
 
Published on
October 8, 2024




2024–25 RSV Season and Synagis Prior Authorization Begins for State Health Regions

The Texas Health and Human Services Commission will open the 2024-25 monthly prophylaxis for RSV on Oct. 1, 2024. Review the schedule for each region's start and end dates. Refer to the Vendor Drug Program website for more information.

  • Originally published on Vendor Drug Program website on Sept. 24, 2024.
 
Published on
October 8, 2024




Agenda for July 2024 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board agenda for Friday, Oct. 25, 2024, is now available. 

Refer to the Texas Drug Utilization Review Board Handbook for instructions on 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 and the Public Comment Registration available on the agenda.

 
Published on
October 5, 2024




Members Sought for the Drug Utilization Review Board
HHSC will accept applications to be a Texas Drug Utilization Review Board member until Nov. 1. 2024. Refer to the Vendor Drug Program website for more information.

Published on
October 5, 2024



HHSC To Remove Oxbryta Products From All Formularies As Of Oct. 10, 2024 

HHSC will remove several Oxbryta products from all formularies on Oct. 10, 2024. Refer to the Vendor Drug Program website for more information. 
 
Published on  
October 5, 2024 


​Pharmacy Contact Information Must Be Current in PEMS

Medicaid-enrolled pharmacy providers must verify your enrollment and contact information is correct, including:​
  • Telephone number
  • Fax number
  • Pharmacy type (retail, long-term care, or specialty)
  • Hours of operation
  • Email address
For more information, call the TMHP Contact Center at 800-925-9126.

Refer to the Vendor Drug Program website for more information.

Published on
October 2, 2024​


Pharmacy Education Information and Opportunities

Pharmacies enrolled with HHSC are uniquely positioned to help individuals with their pharmacy benefits. Pharmacy staff must know what pharmacy items Medicaid pays for, which products require prior authorization, and who to contact with questions about claim processing. 

Refer to the Pharmacy Provider Procedure Manual to learn more information about the following topics:
​Refer to the Vendor Drug Program website for more information.

Published on 
10/2/24


 



Reminder: VDP Changed PDL Status for "Glucocorticoids, Inhaled" Drug Class on Dec. 15, 2023

The manufacturer of the brand name Flovent HFA discontinued their products on Dec. 31, 2023. Due to this discontinuation, HHSC removed the non-preferred status from the authorized generic (AG) fluticasone HFA and brand name QVAR Redihaler products, as shown in the table below. These changes allowed providers to prescribe the authorized generic (AG) fluticasone HFA and brand name QVAR Redihaler products without requiring a PDL prior authorization and continue access to necessary medication for members.

NDC​Drug Name
66993007896
 FLUTICASONE PROP HFA 44 MCG
66993007996 FLUTICASONE PROP HFA 110 MCG
66993008096
 FLUTICASONE PROP HFA 220 MCG
59310030240 QVAR REDIHALER 40 MCG
59310030480
 QVAR REDIHALER 80 MCG
 

Published on 
September 11, 2024​



Clinical Prior Authorization Assistance Chart Now Available

An update to the Clinical Prior Authorization Assistance Chart is available. The chart is a quarterly update identifying the clinical prior authorizations each MCO uses and how those relate to those used for traditional Medicaid claim processing. Refer to the Vendor Drug Program website for more information.

Published on
August 10, 2024





"DUR Reject Error" Claim Processing Issue Corrected 
 
VDP updated its pharmacy claims system to fix an earlier error with claims rejecting with National Council for Prescription Drug Programs (NCPDP) error code 88 (DUR Reject Error). The error affected claims submitted beginning March 31, 2024. Gainwell Technologies fixed the system on July 16, 2024. 

Pharmacies receiving this error for fee-for-service Medicaid, Children with Special Health Care Needs Services Program, Kidney Health Care, or Healthy Texas Women Program claims should resubmit the claim. If you experience reprocessing issues, call the Gainwell Pharmacy and Technical Call Center at 800-435-4165, Monday to Friday, from 7 a.m. to 7 p.m.    
 
Published on:  

August 8, 2024 



Texas Vendor Drug Program (VDP) Provider Portal for Pharmacies and  Prescribers : Electronic Remittance Advice, Portal Training, Technical Support 

The Texas Vendor Drug Program (VDP) requires all providers to register for the VDP Provider Portal. The VDP Provider Portal is intended for prescribers and pharmacies.  
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  
Portal Registration 
People attempting to register for the VDP Provider Portal should collect the following three 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 have entered all three numbers correctly. Refer to the TX VDP Provider Portal Registration User Guide for details on how to register or the 835 Companion Guide for technical information on 835 ERAs. 
The 835 Electronic Remittance Payment Advice allows the automated matchup of claims payment data sent to Gainwell.  

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.    
VDP Provider Portal Training Sessions 
You can review the previously recorded portal Training session that is available to view in the Gainwell Learning Management System (LMS).  
To View VDP Provider Portal Training: 
  1. A specific enrollment key is required to register. Email mmislearningcenter.myabsorb.com for the enrollment key. Include your name, company name, and National Provider Identifier (NPI) in the email. It may take up to two business days to receive the enrollment key. 
  2. Sign up to register for the Gainwell LMS
  3. 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 the VDP provider portal training course. 
For the complete user guide, refer to the HYPERLINK: TX VDP Provider Portal Registration User Guide 

Technical Support and Electronic Remittance Advice Support 
For technical support, or 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 on 
August 3, 2024 




Aug. 2024 Preferred Drug List Now Available

The Aug. 2024 Medicaid Preferred Drug List is available. This update includes changes approved at the Jan. and April 2024 Drug Utilization Review Board meetings. The document includes formulary and prior authorization information, notations for drugs requiring clinical prior authorization, the review schedule, and appendices for cough and cold products, iron oral agents, and prenatal vitamins products.
HHSC designates drugs on the Texas Medicaid formulary as preferred, non-preferred, or have neither designation. The preferred drug list includes only drugs identified as either preferred or non-preferred:
  • Drugs not on the preferred list, or drugs identified on the list as "preferred", are available to people without prior authorization.
  • Drugs on the list identified as "non-preferred" will require prior authorization.
  • Some preferred and non-preferred drugs may require clinical prior authorization.
Drugs with preferred status drugs may include brand name medication which would not require a PDL prior authorization nor the value of "1" in the "Dispense as Written (DAW) Product Selection code" field (408-D8). Refer to the Dispense as Written section of the Drug Policy chapter of the Pharmacy Provider Procedure Manual for more information.

The PDL changes will appear in the Epocrates drug information system. Epocrates does not mirror the HHSC designations differentiated by dosage form. In these situations, Epocrates accompanies the designation with an explanatory message.

Published on




  • 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.