Program Description
How to Participate
The Vendor Drug Program (VDP) provides services for over 4,000 Texas pharmacies. Pharmacy providers that want to participate must be contracted prior to providing out-patient pharmacy prescription services. All arrangements with software and switching companies should be handled directly by the provider.
All out-patient prescription drug claims for Medicaid, CHIP, CSHCN, and KHC are processed through the VDP point-of-sale system using the National Council for Prescription Drug Programs (NCPDP) telecommunication standard format. The VDP system performs over 100 separate real-time edits, including validation of the submission format; the client, pharmacy, prescriber, and product; identifying any prior authorization requirements or other known insurances; and calculating reimbursement. After submission, the VDP system responds with information regarding client eligibility, Vendor Drug’s allowed amount, applicable Prospective Drug Utilization Review (ProDUR) messages, and applicable rejection messages. Pharmacies can use our eligibility verification tools to obtain out-patient pharmacy eligibility and prescription benefit data.
All claim submission requirements and guidelines are available in our Provider Handbook and Provider Procedure Manual.
The Vendor Drug Pharmacy Resolution Help Desk assists pharmacy providers with claim submittal status and information regarding program policies and procedures. Vendor Drug also maintains field offices across the state to assist with pharmacy education and to review claims activity.
Vendor Drug supports a number of continuing education opportunities for pharmacy staff. Pharmacies can stay up-to-date with us through our quarterly newsletter and the Texas Health and Human Services subscription e-mail service.
All claims are processed for payment weekly. By law, payments can only be made to the provider of services and not to the Medicaid or CHIP client.