Medicare Part B and D Indicators Available on Formulary Searches Beginning June 6

June 6, 2022

On June 6, 2022, HHSC began identifying drugs and products as either a Medicare part B cost-share or Medicare part D wrap-around benefit on the Formulary Drug and Product searches. Users can search by drug or product name, the 11-digit National Drug Code (NDC), or by clicking the Part B or Part D checkbox. Additional filters are available to find products payable by each program.

Refer to the Medicaid with Medicare Part B section of the Pharmacy Provider Procedure Manual (PPPM) to learn more about Medicaid coverage of cost-sharing amounts for Medicaid-Medicaid dual-eligible clients after billing to the Medicare part B plan.

Refer to the Medicaid with Medicare Part D section of the PPPM to learn more about coverage of wrap-around benefits for outpatient drugs, biological products, certain limited home health supplies, and vitamins and minerals for Medicare-Medicaid dual-eligible clients after billing to the Medicare part D.