The Texas VDP 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.
The Texas VDP Pharmacy Provider Payer Sheets define the required fields needed for processing prescription claim by the Vendor Drug Program (such as BIN and process control number) and address certain claim-specific policies (such as for coordination of benefits or 340B claim processing). While this this information should be accessible through your pharmacy software system, all pharmacy staff and their contracted software company can refer back to these payer sheets when questions arise.
Rules and Statutes
Texas Medicaid is subject to both federal and state policies, procedures, rules and regulations, among them:
- Texas Administrative Code, a compilation of all agency rules in Texas
- Texas Government Code, the codification of the state's general and permanent statutes relating to state government
- United States Code of Federal Regulations, the codification of the general and permanent rules and regulations published by the executive departments and agencies of the federal government of the United States