July 16, 2020

Beginning Sept. 21, 2020, VDP will require the "Quantity Prescribed" field (460–ET) on all pharmacy claims for Schedule II drugs.

CMS published a final rule on Jan. 24, 2020, titled ‘‘Administrative Simplification: Modification of the Requirements for the Use of Health Insurance Portability and Accountability Act of 1996 National Council for Prescription Drug Programs D.0 Standard’’ requiring the “Quantity Prescribed” field (460–ET) when processing pharmacy claims for Schedule II drugs. The final rule applies to all health insurance plans, including Medicaid and CHIP.

Pharmacy staff should refer to the payer sheet addendum (PDF) for more information on how this change impacts claim processing. VDP will revise the full B1 payer sheet upon implementation. Contact vdp-operations@hhsc.state.tx.us with comments or questions.

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