The Vendor Drug Pharmacy Product Enrollment unit maintains the Medicaid/CHIP formulary of pharmaceutical products and files of licensed physicians for claims processing.
The Texas Drug Code Formulary covers more than 32,000 line items of drugs including single source and multi source (generic) products. Vendor Drug reimburses providers for outpatient prescription drugs only. Drugs administered in the doctor's office, inpatient hospital, outpatient hospital, or any location other than the client's home, nursing facility, or extended care facility are not a covered Vendor Drug Program benefit. Physician-administered drugs must be provided by the medical provider at the time of administration.
Pharmacies also may provide durable medical equipment (DME) and medical supplies to Medicaid clients as appropriate. Reimbursement for DME is different from drug claims; pharmacy providers must enter into a separate written agreement with HHSC, through the Texas Medicaid & Healthcare Partnership (TMHP). Some clients are enrolled in Medicaid managed care health plans and, for those clients, pharmacies must enter into a contract with their individual health plans to be reimbursed for DME and medical supplies. |
