Pharmacy providers enrolled with the Texas Health and Human Services Commission (HHSC) are in a unique position to help individuals with their pharmacy benefits. It’s important for a pharmacy to know what pharmacy items Medicaid pays for, which products require prior authorization, and who to contact with questions about claim processing. 

Refer to the Pharmacy Provider Procedure Manual to learn more information about the following topics:

• 72-hour emergency overrides for prior authorization-required drugs
• Medicaid managed care pharmacy claims billing information
• Enrolling in the Medicaid Comprehensive Care Program
• Enrolling as a durable medical equipment pharmacy provider
• Eligibility verification tools

Pharmacy Education Resources

Texas Health Steps provides resources for primary care providers and other health professionals, including a pharmacy continuing education course available for credit and three quick courses:

• The pharmacy continuing education course is accredited and includes requirements related to pharmacy enrollment, using the PDL and online formulary, obtaining prior authorization, and dispensing a 72-hour emergency supply of medication.
• A five-minute Dispenser’s Guide to Texas Medicaid Outpatient Pharmacy Benefits quick course for pharmacy providers.
• A five-minute Prescriber’s Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization quick course for prescribing physicians.
• A five-minute Texas Medicaid Mosquito Repellent Benefit quick course for pharmacy providers.

Refer to the Outreach and Education Resources for links to downloadable materials.

You Can Report Drug Shortages to HHSC

Pharmacies and other stakeholders can request expedited formulary coverage, an expedited preferred drug list change, or notify HHSC about potential drug shortages impacting prescribing choice and pharmacy claim processing by using the Drug Shortage Notification and Expedited Formulary or Preferred Drug List Request (HHS Form 1315).

Referrals should recommend an alternative with supply chain in mind so extra demand will not cause another shortage.

You may also subscribe to updates from the U.S. Food and Drug Administration on public health and regulatory topics, including drug recalls, market withdrawals, and safety alerts.