Pharmacy providers with a current license or registration with the Texas State Board of Pharmacy (TSBP) or is licensed under the laws of another state and is free from any pharmacy board restriction may apply to become a Texas Medicaid pharmacy provider. As defined and limited by federal and state laws, prescribing providers authorized and licensed to practice the healing arts and choose to provide pharmaceuticals may also apply to become pharmacy providers. HHSC maintains open enrollment for in-state pharmacies licensed as Class A or C by the TSBP. Pharmacies holding any other class of pharmacy license may be subject to special application procedures.

Refer to TAC Section 354.1801 (Subchapter F: Requirements for Participation). In addition, pharmacy providers must follow federal and state laws relating to counseling and patient medication records, including TAC Section 291.33(c) (Operational Standards) and 291.34(c)(3) (Records). Refer to the Records Retention section for the time required to store pharmacy records.

Prescribing providers enroll through the TMHP Provider Enrollment and Management System (PEMS). Federal law requires HHSC to deny fee-for-service claims for drugs or products prescribed by non-enrolled providers.

Enrollment with HHSC as a Medicaid provider is a prerequisite for participation in the other state programs administered by VDP:

  • Children's Health Insurance Program (CHIP)
  • Children with Special Health Care Needs (CSHCN) Services Program
  • Healthy Texas Women (HTW) Program
  • Kidney Health Care (KHC) Program

Enrollment in Medicaid is also a prerequisite for participation in any Medicaid or CHIP managed care pharmacy network. MCOs must allow any Medicaid-enrolled pharmacy provider willing to accept the terms and conditions of the MCO or pharmacy benefits manager (PBM) contract to enroll in the network. Pharmacies providers should contact the client's specific MCO for details.