Deadline for Draft Adult Vaccines As A Pharmacy Benefit Policy Review Due July 1, 2024

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The HHSC Vendor Drug Program (VDP) accepts stakeholder comments on the following draft policy. The comment period ends July 1, 2024. Submit your comments using the Draft Policy Comment Submission (HHS Form 1342). VDP will consider the comments when developing the final policy and share the final policy and implementation information at a later date.

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Background

HHSC proposes adding adult vaccine coverage to the Medicaid formulary in response to stakeholder feedback requesting increased access to adult vaccines. In Texas, pharmacists can administer the following vaccines:

  • COVID-19 vaccine
  • Hepatitis A vaccine
  • Hepatitis B vaccine
  • Hib vaccine
  • Human Papillomavirus (HPV) vaccine
  • Influenza vaccine
  • Measles, Mumps, Rubella (MMRV) vaccine
  • Meningococcal vaccine
  • Mpox vaccine
  • Pneumococcal vaccine
  • Poliovirus vaccine
  • Respiratory Syncytial Virus (RSV) vaccine
  • Shingles vaccine
  • Tetanus-Diphtheria-Pertussis (Tdap) vaccine
  • Tetanus-Diphtheria (Td) vaccine
  • Varicella vaccine

Draft Policy

HHSC already covers influenza and COVID-19 vaccines on the Texas Medicaid formulary and proposes adding the additional vaccines listed above for adults ages 19 years and older enrolled in Medicaid. VDP may add additional vaccines in the future to the formulary as they are approved by the state for pharmacist administration.

Administering pharmacists are health care professionals licensed by the Texas State Board of Pharmacy (TSBP) to practice pharmacy, who have met and maintained the eligibility requirements outlined in Texas Administrative Code (TAC) Title 22 Part 15 Chapter 295 and are certified by the Accreditation Council for Pharmacy Education to administer vaccines. Administering pharmacists are under the supervision of a physician and may administer immunizations or vaccinations only pursuant to a written protocol from a physician authorizing the administration.

The pharmacist administering the vaccine or immunization does not have to enroll with Medicaid through the Texas Medicaid & Healthcare Partnership (TMHP) but must follow the TSBP’s certification requirements to immunize and vaccinate. Refer to TAC Section 295.15 (Chapter 295: Administration of Immunizations or Vaccinations by a Pharmacist under Written Protocol of Physician).

Administering pharmacists and pharmacies must follow all other applicable laws and regulations related to vaccine administration. 
This policy applies to traditional fee-for-service and managed care Medicaid. Managed care organizations (MCOs) will be required to cover all adult vaccines available on the Texas Medicaid Formulary as part of the pharmacy benefit and will be required to reimburse pharmacies for the ingredient cost and administration fees.

This policy applies to adult vaccines only. For children’s vaccine requirements, refer to the Texas Vaccines for Children Program.

We will add the the final policy to the Pharmacy Provider Procedure Manual, and relocate existing vaccine information into a new subsection with information for each covered vaccine.