Texas Medicaid/CHIP Drug Vendor Program News
Current News
Benefit Stage Qualifier Values
March 4, 2013
Effective March 7, 2013, the Kidney Health Care (KHC) Program will have new claim submission requirements if the primary payer has financial amounts that apply to Medicare Part D beneficiary benefit stages. The following fields will be required when a client participates in a Texas Medicare Part D plan:
For more information, please refer to the NCPDP version D.Ø B1 billing request KHC payer sheet. If you have questions regarding this change, contact KHC Customer Service at (800) 222-3986.
2012-2013 RSV Season Extended to March 31, 2013
February 13, 2013
Due to high levels of Respiratory Syncytial Virus (RSV) statewide, the Texas Health and Human Services Commission will extend the palivizumab season through March 31, 2013, for all counties. A sixth dose will be approved without prior authorization.
MCO medical directors will be allowed to end the RSV season for their health plans, by service area, if they demonstrate to HHSC that the local virology has dropped below 10% positivity for two consecutive weeks.
Preferred Drug List Changes effective January 23, 2013
January 22, 2013
The Texas Health and Human Services Commission Vendor Drug Program will implement changes to the Medicaid Preferred Drug List (PDL) on Wednesday, January 23, 2013. The entire PDL and summary document listing the PDL changes by drug class and by drug name are posted on the Vendor Drug website. The PDL includes the Cough/Cold and Prenatal Vitamins list. Pharmacies should never automatically switch a preferred brand medication to a non-preferred generic equivalent NDC. This is most common with cough and cold preparations.
The PDL also is available on the Epocrates drug information system, which provides access to the list from your Palm, Blackberry, iPhone or other handheld device. The system also provides clinical information, including a drug monograph, dosing and warnings. To register for the service, go to www.epocrates.com and sign up for Epocrates RX. When you select the “Texas Medicaid” formulary, you will be able to search by drug name and see which drugs are preferred, non-preferred or subject to a clinical prior authorization edit. Please note that Epocrates does not mirror the HHSC designations that are differentiated by dosage form. In these situations, the designation is accompanied by an explanatory message.
New Enforcement Date of Amended Texas Administrative Code Rules
January 9, 2013
HHSC is postponing the enforcement of the following amended Texas Administrative Code rules until March 1, 2013:
- § 1 TAC §354.1901, Pharmacy Claims
- § 1 TAC §354.1921, Addition of Drugs to the Texas Drug Code Index
- § 1 TAC §354.1923, Review and Evaluation
- § 1 TAC §354.1927, Retention and Deletion of Drugs
- § 1 TAC §355.8541, Legend and Non-legend Medication
- § 1 TAC §355.8542, Drug Price Effective Date
The effective date of the amended rules is January 14, 2013. HHSC is postponing enforcement of the rules and the requirement to use the new “Certification of Information” document until March 1, 2013. This delay will give manufacturers additional time to make changes to business practices or procedures to comply with the rules.
If you have any questions about VDP’s price reporting requirements, including HHSC’s postponed enforcement of the amended rules, please contact the Vendor Drug Program.
Medicaid Coverage of Barbiturates and Benzodiazepines for Medicare Part D Dual Eligible Clients
December 20, 2012
Effective January 1, 2013, Texas Medicaid will no longer cover barbiturates and benzodiazepines as part of the wraparound benefit for Medicaid clients who are also covered by a Medicare Part D plan (dual eligible). Pharmacies who submit claims for these drugs, for dual eligible clients, with a date of service on or after January 1, 2013, will be rejected (Error Code 41: “MEDICARERX covered drug class Call Medicare 1-800-633-4227”).
Section 1860D- 2(e)(2)(A) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was amended to include barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines. MIPPA further specified that these amendments apply to prescriptions dispensed on or after January 1, 2013. Like any other prescription drug covered under the Part D benefit program, barbiturates and benzodiazepines must meet all other conditions for Part D drugs found in §423.100.
HHSC Drug Use and Expenditure Pattern Quarterly Reports
December 20, 2012
The Vendor Drug Program has posted the Drug Use and Expenditure Pattern quarterly reports for fiscal years 2011 and 2012. The reports provide prescription drug use and expenditure information for the most prescribed individual drugs and therapeutic drug classes. More information about the quarterly reports is available on the Vendor Drug website reports page.
Pharmaceutical & Therapeutics Committee 2012 Meeting Schedule
December 17, 2012
The Pharmaceutical and Therapeutics Committee meeting schedule for 2013 has been posted online.
Texas Drug Utilization Review Board 2013 Meeting Schedule
December 17, 2012
The Drug Utilization Review Board meeting schedule for 2013 has been posted online.
New Application for Participation in the Texas Title XIX Vendor Drug Program
December 7, 2012
On November 16, 2012, a new version of the application for participation in the Texas Title XIX Vendor Drug Program was released. The 2006 version of the application for participation in the Vendor Drug Program will continue to be accepted until December 14, 2012. Beginning December 17, 2012, only the most current version of the contract application (last update: 7/11) will be accepted for pharmacies that would like to enroll in the Vendor Drug Program for the first time, have had a change in ownership, or are currently contracted but need to update key information in accordance with section F1 of the contract. At this time, a request has not been made for current enrolled pharmacies to reapply. For more information about the application procedure please visit the Vendor Drug website.
Pharmaceutical & Therapeutics Committee Recommendations Posted
November 26, 2012
As of March 1, 2012, most Medicaid and all CHIP clients receive their prescription drug benefits through the managed care service delivery model. Health-care professionals that prescribe medications for Medicaid clients must use the Medicaid formulary and Preferred Drug List (PDL), and health-care professionals that prescribe medications for CHIP clients must use the CHIP formulary. Please note there is no PDL for CHIP clients. To ensure that clients receive their pharmacy benefits in a timely and convenient manner, health-care professionals are encouraged to please visit the Vendor Drug website for more information.
Pharmacy Benefits for Medicaid and Children’s Health Insurance Program (CHIP) Clients
November 26, 2012
The Women’s Health Program (WHP) offers family planning services to low-income women who are 18 through 44 years of age. Women who are enrolled in the program will continue to receive family planning services and annual exams, plus, after November 1, HHSC began to reimburse for treatment of sexually transmitted diseases that are found during a family planning exam. To be eligible for Women’s Health Program benefits, women must not receive full Medicaid or CHIP benefits, are not enrolled in a Medicaid managed care plan, and are not enrolled in a Medicare Part A or B. To learn more about WHP products covered by the Vendor Drug program, visit the Women's Health Program product search page.
Pharmaceutical & Therapeutics Committee Recommendations Posted
November 26, 2012
The Pharmaceutical and Therapeutic Committee's recommendations made at the November 2012 meeting regarding which drugs to place on the Medicaid Preferred Drug List have been posted to the Vendor Drug website.
Changes to the Women’s Health Program
November 16, 2012
The Women’s Health Program (WHP) offers family planning services to low-income women who are 18 through 44 years of age. Women who are enrolled in the program will continue to receive family planning services and annual exams, plus, after November 1, HHSC began to reimburse for treatment of sexually transmitted diseases that are found during a family planning exam. To be eligible for Women’s Health Program benefits, women must not receive full Medicaid or CHIP benefits, are not enrolled in a Medicaid managed care plan, and are not enrolled in a Medicare Part A or B. To learn more about WHP products covered by the Vendor Drug program, visit the Women's Health Program product search page.