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Welcome to
Texas Medicaid
Pharmacy Services
Supported by Gainwell Pharmacy Services.
Draft Specialty Drug List Available for Comment, Responses Due March 12
The draft specialty drug list is now available for public comment. HHSC will accept comments on the draft SDL until Wednesday, March 12. The Specialty Drug Handbook outlines the process for including drugs on the SDL and expectations for external comment. Refer to the Vendor Drug Program for more information.
Published on
March 7, 2025
Summary of Jan. 2025 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review (DUR) Board met on Friday, Jan. 31, 2025, 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
The Texas Drug Utilization Review (DUR) Board met on Friday, Jan. 31, 2025, 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
February 19, 2025
Updated Clinical Prior Authorization Assistance Chart Now Available
An update to the Clinical Prior Authorization Assistance Chart (PDF) is available.
HHSC requires MCOs to implement specific clinical prior authorizations for clients enrolled in managed care. Usage of other clinical prior authorizations will vary between MCOs at the discretion of each MCO.
HHSC publishes a criteria guide for each prior authorization with a description of the steps in the evaluation process. All steps apply to traditional Medicaid claims processed by HHSC. The assistance chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
Refer to the MCO Search for the prior authorization call center phone number unique to each MCO and a link to each MCO’s active clinical prior authorizations.
HHSC requires MCOs to implement specific clinical prior authorizations for clients enrolled in managed care. Usage of other clinical prior authorizations will vary between MCOs at the discretion of each MCO.
HHSC publishes a criteria guide for each prior authorization with a description of the steps in the evaluation process. All steps apply to traditional Medicaid claims processed by HHSC. The assistance chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
Refer to the MCO Search for the prior authorization call center phone number unique to each MCO and a link to each MCO’s active clinical prior authorizations.
Published on
Register Now for TMHP's Revalidation Extension and Retroactive Enrollment Period Webinars
The Texas Medicaid & Healthcare Partnership (TMHP) is hosting a series of webinars for Medicaid providers to discuss the revalidation extension dates and enrollment period gaps. Refer to the Vendor Drug Program website for more information and registration details.
Published on
The Texas Medicaid & Healthcare Partnership (TMHP) is hosting a series of webinars for Medicaid providers to discuss the revalidation extension dates and enrollment period gaps. Refer to the Vendor Drug Program website for more information and registration details.
Published on
January 25, 2025
January 2025 NDC-to-HCPCS Crosswalk Now 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 (CAD) processing. Refer to the Vendor Drug Program website for more information.
Published on
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:
You must submit the following information before you register:
To register for access, perform the following steps:
Prescribers can review a recorded portal training session on the Gainwell Learning Management System (LMS).
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.
- 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.
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)
To register for access, perform the following steps:
- On the top of the portal home page, click Register.
- 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.
- Complete the activation steps listed in the email.
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.
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:
You must submit the following information before you register:
To register for access, perform the following steps:
Pharmacies can review a recorded portal training session on the Gainwell Learning Management System (LMS).
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.
- 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.
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)
To register for access, perform the following steps:
- On the top of the portal home page, click Register.
- 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.
- Complete the activation steps listed in the email.
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.
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
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:
Published on
10/2/24
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:
- Submitting 72-hour emergency overrides for prior authorization-required drugs
- Enrolling in the Medicaid Comprehensive Care Program
- Enrolling as a durable medical equipment pharmacy provider
- Using eligibility verification tools
- Using the MCO Search to find managed care claims billing and contact information
Published on
10/2/24
- General
- Provider
Welcome to Texas Medicaid Pharmacy Services Online Portal
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.