Formulary Drug File Layout
Last Updated
This layout document describes the fields in the formulary drug search data file.
| Field Name | Description | Length | Format | Note |
|---|---|---|---|---|
| Drug_Generic | Identifies the generic name of drug | 35 | ||
| Drug_HTW_code | Identifies whether the drug is active on Healthy Texas Women (HTW) Program formulary | 3 | ||
| Drug_limit_fp | Identifies whether the drug is a family planning drug | 3 | ||
| Drug_limit_ds | Identifies whether the drug is a diabetic supply drug | 3 | ||
| Drug_limit_ppg | Identifies whether the drug has premium preferred generic (PPG) pricing | 3 | ||
| Drug_limit_ppg | Identifies the refill utilization percentage | 3 | Refer to the Refill Utilization section of the pharmacy manual for more information | |
| Drug_NDC | Identifies the 11-digit National Drug Code (NDC) number | 11 | ||
| Drug_Descr | Identifies the First Databank (FDB) label name of the drug | 35 | ||
| Drug_Pkg | Identifies the package size of the drug | 12 | ZZZZZZ.99999 | |
| Drug_Unit | Identifies the unit of measure of the drug | 2 |
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| Drug_340B | Identifies the Texas reimbursement rate for 340B drugs | 14 | ZZZZZZ.99999 | |
| Drug_med_EffDate | Identifies the effective date of the drug on Medicaid formulary | 10 | MM/DD/CCYY | |
| Drug_med_EndDate | Identifies the termination date of the drug on the Medicaid formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_Med_Code | Identifies whether the drug is active on the Medicaid formulary | 3 | ||
| Drug_CMP_V | Identifies whether the drug is only available for multi-ingredient compound Medicaid claims | 3 | ||
| Drug_Med_Comment | Identifies any paper prior authorization form requirements for drugs on the Medicaid formulary | 60 | ||
| Drug_chip_EffDate | Identifies the effective date of the drug on CHIP formulary | 10 | MM/DD/CCYY | |
| Drug_chip_EndDate | Identifies the termination date of the drug on the CHIP formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_chip_code | Identifies whether the drug is active on the CHIP formulary | 3 | ||
| Drug_CMP_P | Identifies whether the drug is only available for multi-ingredient compound CHIP claims | 3 | ||
| Drug_cshcn_EffDate | Identifies the effective date of the drug on the CSHCN formulary | 10 | MM/DD/CCYY | |
| Drug_cshcn_EndDate | Identifies the termination date of the drug on the CSHCN formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_cshcn_code | Identifies whether the drug is active on the CSHCN formulary | 3 | ||
| Drug_CMP_C | Identifies whether the drug is only available for multi-ingredient compound CSHCN claims | 3 | ||
| Drug_cshcn_comment | Identifies any paper prior authorization form requirements for drugs on the CSHCN formulary | 60 | ||
| Drug_khc_EffDate | Identifies the effective date of the drug on the KHC formulary | 10 | MM/DD/CCYY | |
| Drug_KHC_EndDate | Identifies the termination date of the drug on the KHC formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_khc_code | Identifies whether the drug is active on the KHC formulary | 3 | ||
| Drug_CMP_K | Identifies whether the drug is only available for multi-ingredient compound KHC claims | 3 | ||
| Drug_htw_EffDate | Identifies the effective date of the drug on the HTW formulary | 10 | MM/DD/CCYY | |
| Drug_htw_EndDate | Identifies the termination date of the drug on the HTW formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_legend_status | Identifies whether the drug is legend or over-the-counter | 21 |
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| Drug_PDL_pa_required | Identifies whether the drug requires a Medicaid non-preferred (PDL) prior authorization | 3 | ||
| Drug_pdl_EffDate | Identifies the effective date of the Medicaid non-preferred (PDL) prior authorization | 10 | MM/DD/CCYY | |
| Drug_MKID | Identifies the drug's preferred prior authorization therapeutic class code | 4 | Refer to the valid values for the PDL therapeutic class description | |
| Drug_Clinical_pa_required | Identifies whether the drug requires a Medicaid clinical prior authorization | 3 | ||
| Drug_Retail | Identifies the current acquisition cost for VDP-identified retail pharmacies | 14 | ZZZZZZ.99999 | |
| Drug_Retail_EffDate | Identifies the effective date of the current acquisition cost for VDP-identified retail pharmacies | 10 | MM/DD/CCYY | |
| Drug_LTC | Identifies the current acquisition cost for VDP-identified long-term care pharmacies | 14 | ZZZZZZ.99999 | |
| Drug_LTC_EffDate | Identifies the effective date of the current acquisition cost for VDP-identified long-term care pharmacies | 10 | MM/DD/CCYY | |
| Drug_SPC | Identifies the current acquisition cost for VDP-identified specialty pharmacies | 14 | ZZZZZZ.99999 | |
| Drug_SPC_EffDate |
Identifies the effective date of the current acquisition cost for VDP-identified specialty pharmacies |
10 | MM/DD/CCYY | |
| Drug_VAC | Identifies the current VDP acquisition cost when the drug does not have retail, LTC, or specialty pricing | 14 | ZZZZZZ.99999 | |
| Drug_VAC_EffDate | Identifies the effective date of the current VDP acquisition cost | 10 | MM/DD/CCYY | |
| Drug_MKID_Desc | Identifies the drug's preferred prior authorization therapeutic class description | 50 | Refer to the valid values for the PDL therapeutic class description | |
| ID | Identifies the 11-digit National Drug Code (NDC) number | 11 | ||
| Drug_med_EndReason | Identifies the reason for the drug's termination from the Medicaid formulary | 50 | ||
| Drug_chip_EndReason | Identifies the reason for the drug's termination from the CHIP formulary | 50 | ||
| Drug_cshcn_EndReason | Identifies the reason for the drug's termination from the CSHCN formulary | 50 | ||
| Drug_khc_EndReason | Identifies the reason for the drug's termination from the KHC formulary | 50 | ||
| Drug_limit_larc | Identifies whether the drug is a long-acting reversible contraception drug | 3 | ||
| Drug_limit_injection | Identifies whether the drug is long-acting injectable or Vivitrol | 3 | ||
| Drug_admin_fee | Identifies the administration cost value | 14 | ZZZZZZ.99999 | |
| Drug_manufacturer | Identifies the name of the drug manufacturer | 15 | ||
| Drug_HTWPLUS_code | Identifies whether the drug is active on HTW Plus Program formulary | 3 | ||
| Drug_htwplus_EffDate | Identifies the effective date of the drug on the HTW Plus formulary | 10 | MM/DD/CCYY | |
| Drug_htwplus_EndDate | Identifies the termination date of the drug on the HTW Plus formulary | 10 | MM/DD/CCYY | A drug with a termination date will appear on the file for 90 days following the termination date |
| Drug_chip_comment | Identifies any paper prior authorization form requirements for drugs on the CHIP formulary | 60 | ||
| Drug_khc_comment | Identifies any paper prior authorization form requirements for drugs on the KHC formulary | 60 | ||
| Drug_medicare-B | Identifies an NDC considered a Medicare Part B covered benefit for dual eligible clients. | 3 | ||
| Drug_medicare-D | Identifies an NDC considered a wrap-around drug for Medicare Part D dual-eligible clients. | 3 | ||
| Drug_sdl_code | Identifies an NDC included on the Specialty Drug List. | 3 | ||
| Drug_sdl_EffDate | Identifies the effective date of an NDC included on the Specialty Drug List. | 10 | MM/DD/CCYY | |
| Drug_sdl_EndDate | Identifies the termination date of an NDC included on the Specialty Drug List. | 10 | MM/DD/CCYY |