Pharmacies enrolled with HHSC are uniquely positioned to help individuals with their pharmacy benefits. Pharmacy staff must 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:

• Submitting 72-hour emergency overrides for prior authorization-required drugs
• Enrolling in the Medicaid Comprehensive Care Program
• Enrolling as a durable medical equipment pharmacy provider
• Using eligibility verification tools
• Using the MCO Search to find managed care claims billing and contact information

Texas Health Steps 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.