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Texas Medicaid
Pharmacy Services
Supported by Gainwell Pharmacy Services.
Published on
April 25, 2024
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
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
Beginning March 15, 2024, Gainwell notified pharmacies and prescribers by USPS with the portal link and credentials.
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:
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:
Clinical Prior Authorization Updates
Clinical prior authorizations may implement for traditional Medicaid and managed care at any time:
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 Class | Drug | Current PDL Status | Recommended Status |
Acne Agents, Topical | Adapalene gel OTC (topical) | Non-Preferred | Preferred |
Acne Agents, Topical | Cabtreo gel (topical) | Non-Reviewed | Preferred |
Acne Agents, Topical | ZMA Clear Cleanser (topical) | Non-Reviewed | Preferred |
Analgestics, Narcotics Long | Tramadol ER (Ryzolt) (oral) | Preferred | Non-Preferred |
Bladder Relaxant Preparations | Vesicare (oral) | Preferred | Non-Preferred |
Glucagon Agents | Gvoke Pen (subcutaneous) | Preferred | Non-Preferred |
Glucagon Agents | Zegalogue Autoinjector (subcutaneous) | Non-Preferred | Preferred |
Movement Disorders | Austedo XR (oral) Austedo XR (oral) | Non-Reviewed | Preferred |
Movement Disorders | Tetrabenazine (oral) | Non-Preferred | Preferred |
Movement Disorders | Xenazine (oral) | Preferred | Non-Preferred |
Neuropathic Pain | Dermacinrx Lidocan patch (topical) | Non-Reviewed | Non-Preferred |
Neuropathic Pain | Lidocaine (AG) (topical) Lidocaine (topical) | Non-Reviewed | Preferred |
Neuropathic Pain | Lidocan II (topical) | Non-Reviewed | Non-Preferred |
Neuropathic Pain | Xyliderm (topical) | Non-Reviewed | Non-Preferred |
Oncology, Oral – Lung | Augtyro capsule (oral) | Non-Reviewed | Preferred |
Oncology, Oral – Lung | Rozlytrek pellet pack (oral) | Non-Reviewed | Preferred |
Oncology, Oral – Lung | Xalkori pellet (oral) | Non-Reviewed | Preferred |
PAH Agents, oral and inhaled | Liqrev Suspension (oral) | Non-Reviewed | Non-Preferred |
PAH Agents, oral and inhaled | Orenitram Titration Kit (oral) | Non-Reviewed | Non-Preferred |
Phosphate Binders | Xphozah tablet (oral) | Non-Reviewed | Non-Preferred |
Stimulants and Related Agents | Qelbree (oral) | Non-Preferred | Preferred |
Stimulants and Related Agents | Relexxii (oral) | Non-Reviewed | Non-Preferred |
Anticonvulsants | Motpoly XR (oral) | Not Reviewed | Preferred |
Opiate Dependence Treatments | Narcan Spray OTC (Nasal) | Not Reviewed | Preferred |
Antipsychotics | Rykindo (intramusc) | Not Reviewed | Non-Preferred |
Cytokine and CAM Antagonists | Adalimumab-Adbm Kit (Injection) (Cf) 50 Mg/Ml | Not Reviewed | Non-Preferred |
Cytokine and CAM Antagonists | Adalimumab-Adbm Pen Kit (Injection) (Cf) 50 Mg/Ml | Not Reviewed | Non-Preferred |
Cytokine and CAM Antagonists | Entyvio Pen (Subcutane) | Not Reviewed | Non-Preferred |
Erythropoiesis Stimulating Proteins | Jesduvroq Tablet (oral) | Not Reviewed | Non-Preferred |
Glucocorticoids, Inhaled | Airsupra Hfa (Inhalation) | Not Reviewed | Non-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:
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:
***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 regular 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
Field Number | Field Name | Medicaid, CSHCN | KHC |
101-A1 | Bank Identification Number (BIN) | 025417 | 025417 |
104-A4 | Processor Control Number | DRTXPROD | DRTXPRODKH |
301-C1 | Group ID | MEDICAID CSHCN | KHC |
VDP Provider Portal
Prior Authorization
Rebate Inquiries
Updated: March 31, 7:05 a.m.
Published on March 27, 2024