CMS sends Texas quarterly updates to the Unit Rebate Amounts (URA) for each manufacturer, approximately forty-five days after the end of the calendar year quarter. URAs are computed by CMS based on information submitted by manufacturers. The Texas VDP rebate system loads all drug data and manufacturer information from CMS. 

HHSC computes URAs for the CHIP, CSHCN, HTW, and KHC programs separately, and loads the information into the rebate system from separate files (see section 4). 

HHSC invoices manufacturers for rebates on all fee-for-service (FFS) claims and managed care encounters loaded into the rebate system every quarter. CMS requires the generation and transmission of federal rebate invoices within 60 days after the end of each calendar quarter. Supplemental rebate invoices are generated and transmitted 75 days after the end of each calendar quarter. 

Drug rebate invoices are calculated based on 11-digit NDCs, drug quantity units on paid claims (original, coordinated, and adjusted claims), URA, interest owed, and prior period adjustments (PPA). Manufacturers request claim level detail to confirm utilization by contacting Conduent State Healthcare, the VDP pharmacy claims and rebate administration vendor, at PCRA_CLDandDisputes@Conduent.com. 

An invoice is created for each program. Applicable program names and descriptions are included in the title of the invoice. Refer to the list of program names (as of Sept. 1, 2020) in Table 1.

Table 1: HHSC Invoice Programs

Program Name

Program Description

TXMED

Fee-for-Service Medicaid pharmacy claims

TXSUPP

Supplemental Fee-for-Service Medicaid pharmacy claims 

TXEFMAP

Fee-for-Service Medicaid pharmacy claims based on special grant requirements

TXEFMAPSUP

Supplemental fee-for-service Medicaid pharmacy claims based on special grant requirements

TXMCO

Managed care Medicaid pharmacy claims

TXMCOSUP

Supplemental Medicaid managed care pharmacy claims

TXMCOEFMAP

Managed care Medicaid pharmacy claims based on special grant requirements

TXMCOEFMAPSUP

Supplemental Medicaid managed care pharmacy claims based on special grant requirements

TXJCODE

Drugs extracted from Fee-for-service Medicaid medical claims

TXMCOJCOD

Drugs extracted from Medicaid managed care medical claims

TXEFMAPJCOD

TXEFMAPJCODE – Drugs extracted from Medicaid Fee-forService Medical Claims based on Special Grant Requirements

TXMCOEFMAPJC

Drugs extracted from Medicaid managed care medical claims based on special grant requirements

CNSF

Children’s Health Insurance Program (CHIP) Not State Funded 

BCCP

Fee-for-service breast and cervical cancer pharmacy claims

Program Name

Program Description

KHC

Kidney Health Care Program

CSHCN

Children with Special Health Care Needs Services Program

TWHP

Texas Women’s Health Program.  The state-funded portion of the Healthy Texas Women’s Program serving women under 18 years of age. 

TXMCOBCCP

Managed care breast and cervical cancer pharmacy claims

    HTW                              Healthy Texas Women Program.  The Federally Funded

portion of the Healthy Texas Women’s Program subject to CMS rebate rules serving women 18 years of age and older.