Vendor Drug Program Systems Changing Next Year

In 2022, the Texas Health and Human Services Commission (HHSC) announced a contract award of its Vendor Drug Program pharmacy claim, rebate administration, and prior authorization systems to a new vendor, Gainwell Technologies, LLC. Gainwell will be responsible for the following functions:

• Fee-for-service Medicaid and other state program pharmacy claims processing
• Administration of federal, supplemental, and value-based rebates
• Preferred drug list and value-based rebate negotiations
• Fee-for-service Medicaid and other state program pharmacy prior authorization administration
• Formulary management, including the electronic Certificate of Information for formulary addition
• Drug utilization review activities
• Pharmacy, prior authorization, and technical call centers

Pharmacy enrollment will continue unchanged through TMHP.

VDP will transition to the new systems in early 2024. In the weeks ahead, VDP and Gainwell will provide more information, including testing and training schedules.