S-3.1. Submission Spreadsheet

Specialty Drug Submission Spreadsheet

Contact Tab

HHSC requests the following information on the Contact tab of the submission spreadsheet:

  • Date of submission
  • Name of person submitting the request
  • Name of organization
  • Email address and contact phone number
  • The calendar year and a month of the SDL recommendation

Criteria Tab

HHSC includes the specialty drug criteria as a reference.

Layout Tab

The layout tab includes the fields required for submission on the Submit tab. HHSC requires the following information to consider your submission.

Column Field Description
A NDC 11-digit national drug code number
B Drug name Name of product
K Criteria #1 Justification Stakeholder provides a detailed explanation of how NDC does or does not meet all of criteria #1
M Criteria #3 Justification Stakeholder provides a detailed explanation of how NDC does or does not meet all of criteria #3 
N Criteria #4 Justification Stakeholder provides a detailed explanation of how NDC does or does not meet all of criteria #4
O Final Recommendation Status Stakeholder identifies one of the following selections:
  • Add: meets the three criteria on this document
  • Remove: does not meet at least one criteria on this document

Submit Tab

HHSC requests the following information on the Submit tab of the submission spreadsheet:

  • 11-digit national drug code number (column A)
  • Name of product (column B)
  • A detailed explanation of how the drug does or does not meet criteria #1 (column K), criteria #3 (column M), and criteria #4 (column N).
    • Your justification should explain the drug’s complex education or treatment maintenance and list the name (and NPI, if known) of the pharmacies limited to dispensing the drug. Simply identifying a drug that meets or does not meet the criteria is insufficient, and HHSC will return submittals without adequate information.
  • The stakeholder should identify the final recommendation status (column O) as either one of the two selections:
    • Add: meets the three criteria
    • Remove: does not meet at least one criteria
  • Stakeholders should add new rows to the document as needed.

Stakeholders can manually enter drug information into this tab or copy a specific row from a published SDL.

Submission

Stakeholders should save a copy of the spreadsheet locally and ensure you complete all fields before sending the file to HHSC at vdp-formulary@hhsc.state.tx.us.