Welcome to
Texas Medicaid
Pharmacy Services
Supported by Gainwell Pharmacy Services.
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.
HHSC requires application fees for pharmacies enrolling with Medicaid. The fee for applications submitted in the calendar year 2026 will be $750.00. Refer to the
Vendor Drug Program website for more information.
