Fee-for-service Delivery Incentive

Pharmacy providers offering no-cost delivery services to Medicaid fee-for-service clients are eligible for the delivery incentive. HHSC will pay a delivery incentive in the amount published in the Medicaid State Plan (hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/state-plan) for each prescription paid by HHSC.

The pharmacy provider must meet the following conditions for payment of the delivery incentive:

  • Advertise to eligible people the availability of the no-charge prescription service
  • Display the HHSC-approved delivery sign in a prominent place in the store (e.g., window, door)
  • Deliver to the Medicaid clients in the same manner and degree as the public.

HHSC does not pay a delivery incentive for the following:

  • Over-the-counter drugs, including those prescribed as a VDP benefit
  • Claims for clients residing in a nursing home or other similar group facility
  • Claims for vitamin and mineral products or home health supplies

Refer to the Provider Payment Calculation to learn how HHSC applies the delivery incentive during the reimbursement calculation.

Pharmacy providers approved for delivery must display the HHSC-approved Pharmacy Delivery Sign in a prominent place within the store. The sign measures 8.5 inches by 5.5 inches, is written in English and Spanish, and displays the HHSC logo.