Pharmacy Provider Procedure Manual

The Texas Medicaid Pharmacy Provider Procedure Manual defines policies and procedures for Medicaid-enrolled pharmacy providers regarding outpatient pharmacy claims, including drug benefit guidance, pharmacy prior authorization, coordination of benefits, and drug pricing and reimbursement.

Chapter Date Revised
Pharmacy Provider Procedure Manual (PDF) 05/01/2017
Provider Enrollment & Maintenance (PDF) 02/01/2017
Managed Care (PDF) 09/01/2016
System Requirements (PDF) 07/01/2016
Client Eligibility (PDF) 07/01/2016
Coordination of Benefits (PDF) 07/01/2016
Home Health Supplies (PDF) 07/01/2016
Vitamin and Mineral Products (PDF) 08/01/2016
Drug Utilization Review (PDF) 07/01/2016
Prior Authorization (PDF) 01/01/2017
Drug Pricing & Reimbursement (PDF) 05/01/2017
Health Resources Services Administration (PDF) 05/01/2017
Pharmacy Payment (PDF) 09/01/2016
Pharmacy Audits (PDF) 07/01/2016
Drug Rebates (PDF) 07/01/2016

Pharmacy Prior Authorization Manual

Texas Medicaid Provider Procedures Manual

The Texas Medicaid Provider Procedures Manual (TMPPM) is a comprehensive guide for Texas Medicaid providers. It contains information about Texas Medicaid fee-for-service benefits, policies, and procedures including medical, dental, and children’s services benefits.