Deadline for Draft VDP Policy Review Due Feb. 16, 2024
The HHSC Vendor Drug Program (VDP) accepts stakeholder comments on the following draft policy. The comment period ends Feb. 16, 2024. Submit your comments using the Draft Policy Comment Submission (HHS Form 1342). VDP will consider the comments in the development of the final policy, and will share the final policy and implementation date for Medicaid in the future.
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Background
The Texas Health and Human Services Commission (HHSC) drafted this policy to apply a uniform 90-day supply of maintenance medications in Medicaid and the Children’s Health Insurance Program (CHIP). HHSC received feedback from stakeholders expressing difficulty obtaining a 90-day supply of medication. Stakeholders requested a uniform policy for maintenance medications when appropriate. HHSC will consider the comments in the development of the final policy. The effective date for the final policy is to be determined.
Draft Policy
The policy allows a 90-day supply of maintenance medication(s) to be filled and dispensed at one time for members in Medicaid fee-for-service and managed care and CHIP.
HHSC is defining “maintenance therapy” as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life or therapy that is performed to maintain or prevent deterioration of a chronic condition. This definition is consistent with the definition used by the Centers for Medicare and Medicaid Services. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma, and diabetes.
Maintenance therapy includes specialty drugs as long as the specialty drugs meet the above definition of maintenance therapy. Exclusions to this uniform policy are medications used for a limited duration of therapy or for acute situations. Examples of these exclusions include anti-infectives, injectables, drugs prescribed for acute pain control, as needed anxiety medications and oncology medications.