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Texas Medicaid/CHIP Vendor Drug Program
News Updates |
The Texas Health and Human Services subscription e-mail service makes it easier for the public to keep up-to-date on the latest news and information about health and human services, including the Medicaid/CHIP Vendor Drug Program. Users can select items of interest from a menu of categories covering all five Texas Health and Human Services agencies.
Those who opt to receive Vendor Drug notices will receive an email message when information is published that impacts pharmacy providers, including: new pharmacy initiatives, issues that affect payment, special bulletins, updates to the Medicaid Preferred Drug List (PDL), publication of the Rx Update newsletter, and improvements to the Vendor Drug Program website. |
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News items:
- February 8, 2010:
Payment delay
(Presidents day)
- January 11, 2010: Payment delay (Martin Luther King, Jr. Day)
- January 7, 2010: Federal Deficit Reduction Act reminder
- January 7, 2010: January Rx Update newsletter
- January 6, 2010: Billing Reminder: Submitting the Correct Prescriber on Pharmacy Claims
- December 23, 2009: Medicaid Coordination of Benefits billing during Holiday season
- December 16, 2009: Vendor Drug Program Pharmacy Education Reminders:
Submitting an emergency override of Prior Authorization required drug;
Separate billing for Durable Medical Equipment;
Sign-up for online Continuing Medicaid Education courses;
Comprehensive Care Program assists Medicaid children;
Avoid the wait, submit an Eligibility Verification (E1) transaction;
Recognizing the Medicaid Eligibility Verification Form (1027-A)
- December 9, 2009: Tamiflu Suspension
- November 10, 2009: Payment Delay (CHIP)
- November 4, 2009:
New MAC drugs begin November 23,
2009
- October 20, 2009: October RX Update
- October 20, 2009: Pharmacist Administration of
Immunizations
- October 6, 2009: CHIP Tamiflu Claims Rejecting for “Drug Not Covered”
- September 25, 2009: Average Wholesale Price reduction
- September 14, 2009: Payment delay (KHC and CSHCN)
- September 1, 2009:
Payment delay (Labor Day)
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September 1, 2009: Vendor Drug Program Pharmacy Education Reminders:
Submitting an emergency override of Prior Authorization required drug;
Separate billing for Durable Medical Equipment;
Sign-up for online Continuing Medicaid Education courses;
Comprehensive Care Program assists Medicaid children;
Avoid the wait, submit an Eligibility Verification (E1) transaction;
Recognizing the Medicaid Eligibility Verification Form (1027-A)
- August 26, 2009: Maintenance Scheduled
for Vendor Drug Claim system August 29-30
- August 26, 2009:
New MAC drugs begin September 9,
2009
- August 25, 2009:
Medicaid/CHIP payment delay
- August 24, 2009: Reminder: STAR Health program
- August 6, 2009:
Texas Drug Utilization Review Board meeting announcement
- August 6, 2009:
Texas Pharmaceutical and Therapeutics Committee meeting announcement
- July 27,
2009: CHIP Payment Delay
- July 22, 2009: Preferred Drug List update
- July 21, 2009: Reminder: CHIP Family Planning Codes
- July 20, 2009: Reminder: Eligibility Verification (Transaction Code E1)
- July 14, 2009:
CMS Conference Call for Medicaid Integrity Provider Audit | [About the audit]
- July 10, 2009: July Rx Update
- July 10, 2009: Reminder: Medicaid Eligibility Verification Form (1027-A)
- July 9, 2009: Cost Avoidance Phase II Implementation
- July 9, 2009: Maintenance Scheduled for Vendor Drug Claim system July 11-12
- June 23, 2009: MAC Drug update
- June 11, 2009: Reminder: Separate billing for Outpatient Prescriptions and DME
- June 11, 2009: Reminder: 72-hour emergency override instructions
- June 11, 2009: Reminder: Comprehensive Care Program
- June 11, 2009: Reminder: Online Continuing Medicaid Education Courses
- June 11, 2009: TMHP Requests Provider Feedback on Medicaid Workshops
- May 29, 2009: MiraLax Reinstated to Formulary Effective May 26
- May 26, 2009:
CMS Medicaid Integrity Group Audit
- May 18, 2009:
Payment delay (Memorial Day)
- May 14, 2009: Maintenance Scheduled for Vender Drug claim system
- April 24, 2009:
MAC Drug update
- April 22, 2009:
April
Rx Update published
- April 22, 2009: DUR Meeting scheduled for April 23 has been postponed
- March 27, 2009:
Reminder: Medicaid Eligibility Verification Form (1027-A)
- March 27, 2009:
Reminder: Online Continuing Medicaid Education Courses
- March 27, 2009:
Reminder: Separate billing for Outpatient Prescriptions and DME
- March 27, 2009: Reminder: 72-hour emergency override instructions
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December 9, 2009: Tamiflu Suspension
The compounding procedure for Tamiflu suspension is provided for emergency use only when the suspension is not commercially available. Medicaid requires that providers dispense the quantity prescribed or ordered by the prescriber except as limited by the policies and procedures described in the Commission's Pharmacy Provider Handbook.
Furthermore, providers must bill for the amount actually dispensed and the quantities actually used in the compound. Claims can only be submitted for the actual amount prescribed. Claims must reflect the actual number of capsules used to make the compound. You cannot bill for 10 capsules if 4, 6, or 8 capsules were used to dispense the prescribed quantity of Tamiflu suspension.
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October 6, 2009: CHIP Tamiflu Claims Rejecting for
“Drug Not Covered”
Tamiflu is covered by the
Children’s Health Insurance Program (CHIP). However, the Texas
Medicaid/CHIP Pharmacy Resolution Help Desk has received a number of
calls about CHIP claims for Tamiflu suspensions rejecting for error
code 7Ř (“Drug Not Covered”).
The “Drug Not Covered” rejection applies to the suspending vehicle
(i.e. Ora Plus, Ora Sweet, etc.) that stores are mixing with Tamiflu.
This rejection can be overridden at the store level by entering an
“8” in the “Submission Clarification Code” field (420-DK).
Providers should contact their software provider for assistance in
submitting this field or refer to the
Vendor Drug Pharmacy Procedure Manual.
In addition, the Texas Department of State Health Services has put
together seasonal flu information for individuals, families and
health care professionals at
TexasFlu.org.
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September 25, 2009: Average Wholesale Price Reduction
On Saturday, September 26, 2009, First DataBank (FDB), a major pharmaceutical pricing service, plans to reduce the Average Wholesale Price (AWP) by approximately 4 percent for approximately 1,400 drug products identified in New England Carpenters Health Benefits Fund, et al, v. First DataBank, Inc.and McKesson Corporation. The Vendor Drug Program performs its own drug pricing and is not dependent on private pricing services, such as FDB. We receive pricing information directly from drug manufacturers. We will not make immediate, automatic changes to the AWP in Texas. As manufacturers send us new pricing information, it will be updated in our system, including any changes to the AWP.
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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. |
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