October 20, 2009: Pharmacist Administration of Immunizations

Effective October 1, 2009, pharmacies and pharmacists can enroll to administer immunizations to Texas Medicaid clients.  Pharmacies will be reimbursed for the vaccines and their administration through the Texas Medicaid & Healthcare Partnership (TMHP).  Pharmacies must be enrolled with TMHP to bill for the administration of the vaccines.

To enroll, a pharmacist must obtain and provide proof of Texas Board of Pharmacy licensure and certification to administer vaccinations.  A criminal background check will be performed on all pharmacists who submit an application.  All providers who enroll must first be enrolled as a Medicare provider.

Pharmacies may complete an online enrollment application via the TMHP website.  TMHP will have a shortened enrollment application for pharmacies currently enrolled as durable medical equipment providers.  Those using the shortened application form will need to submit a full application within six months.  A completed application must be submitted to TMHP before the end of the six-month period to continue to be reimbursed by Texas Medicaid.  The shortened form is also available online.  

The H1N1 vaccine will be covered by Medicaid through TMHP.  TMHP will only pay the administration fee.  The federal government will provide the H1N1 flu vaccine to pharmacies free of charge. Pharmacies will need a medical director to receive the vaccine, and the medical director will have to place orders.  The antivirals Tamiflu and Relenza are covered Vendor Drug items.  They will not need prior authorization approval and will not count in the three prescriptions per month limit.  For information about influenza, please visit the texasflu.org.

Pharmacists are reminded to enter all immunization information into the ImmTrac system, the Texas immunization registry developed by the Texas Department of State Health Services.

May 3, 2010: Certain Pancreatic Enzyme Drugs Removed from the Vendor Drug Formulary

The Centers for Medicare & Medicaid Services (CMS) has notified the Texas Medicaid Vendor Drug Program in a letter dated April 29, 2010, that Vendor Drug must remove certain pancreatic enzyme drugs from its formulary.  The Food and Drug Administration (FDA) has determined the following Exocrine Pancreatic Insufficiency drugs are unapproved new drugs, and cannot be marketed without appropriate FDA approval.  Because these drugs do not have an approved FDA application, CMS has determined that the following drugs do not meet the definition of a covered outpatient drug, and must be removed from the Vendor Drug Formulary.  Please refer to this attachment for drugs that are no longer available for reimbursement through Vendor Drug effective April 30, 2010, and for drugs that are still available through the Vendor Drug (including the new formulation of Creon).

May 5, 2010: Pharmacy Resolution Help Desk Technical Problems

The Medicaid/CHIP Vendor Drug Pharmacy Resolution Help Desk is continuing to experience system issues that began early Monday, May 3. As a result of these issues, calls from pharmacy providers are taking much longer to complete, and callers may get a busy signal.  HHSC is working to resolve the issue as quickly as possible. In the meantime, here are some reminders about inquiries that pharmacies can complete without having to call the Help Desk.

Eligibility Verification:  Vendor Drug encourages pharmacy providers to use their point-of-sale system to submit an Eligibility Verification (E1) Transaction to check eligibility status. If you do not know an individual’s Cardholder ID, you can submit the individual’s Social Security number, preceded by an ‘S’ (e.g., S123456798), to receive the client’s Cardholder ID on the returned response.  Payer sheets for the E1 transaction are available in the Vendor Drug Procedure Manual.

National Drug Code (NDC) Inquiry: If you have a denied claim with the message “NDC Not Covered” and you need to determine what NDCs are covered, please refer to the online Vendor Drug formulary.  The online product details will provide an effective date and end date (if applicable) for each program (Medicaid, CHIP, CSHCN, or KHC).

Prior Authorization (PA) Inquiry: If you are submitting a claim that requires a PA, the Prescriber will need to request the PA from the PA Texas Call Center at 1-877-PA-TEXAS (1-877-728-3927).  Vendor Drug staff cannot remove the requirement for a PA.

We appreciate your patience and understanding as we continue working to resolve our technical difficulties and return to providing you timely service.

July 14, 2010: Vendor Drug Extends Life of Prescription

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) approved the state’s amendment to increase the dispensing life of a Medicaid prescription from six months to one year for non-controlled substances and allow a maximum of up to 11 refills within a one-year period. The Vendor Drug Program will implement these changes on claims beginning Thursday, July 15, 2010.

August 6: New Pharmacy Claims System Postponed

The migration of the Texas Vendor Drug Program’s pharmacy claims processing system has been postponed.  The migration was scheduled to occur on Monday, August 23, 2010, but will be rescheduled for a new date later this year.  Progress has been made toward completion of the new system.  Many pharmacies have successfully submitted test claims.  However, HHSC will take additional time to thoroughly test all aspects of the new system to ensure there is no interruption of service or payment.  HHSC will notify pharmacies and schedule additional pharmacy training sessions when a new implementation date is set.  Until further notice, all scheduled educational webinars are canceled and pharmacy providers should continue to submit their prescription claims as they do today.

August 23: Reminder: New Pharmacy Claims System Postponed

The migration to the new pharmacy claims processing system was scheduled to occur today, but has been rescheduled for later this year.  This means all changes and new functionalities mentioned on our website and in our correspondence are delayed, including using the new Bank Information Number (BIN) and the new Processor Control Numbers (PCN), submitting the Prescriber National Provider Identifier (NPI), and any changes involving pharmacy payment and remittance advices.  Please continue to submit all pharmacy B1, B2, and E1 transactions as you have done previously using the following information, where applicable:  

• For all transactions, submit “Ø12338” in the “Bank Information Number” (BIN) field (1Ø1-A1).
• For all Medicaid, CHIP, and CSHCN claims, submit “PØ28Ø12338” in the “Processor Control Number” (PCN) field (1Ø4-A4).
• For all KHC claims, submit “PØ26Ø12338” in the PCN field.
• For all transactions, submit the 5-character State License Number in the “Prescriber ID” field (411-DB).
• Ensure you are also submitting “Ø8” in the “Provider ID Qualifier” field (466-EZ).