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
Introduction (PDF) Aug. 2017
Contact Information (PDF) Aug. 2017
Provider Enrollment & Maintenance (PDF) Jun. 2017
Managed Care (PDF) Jun. 2017
System Requirements (PDF) Jun. 2017
Client Eligibility (PDF) Jun. 2017
Coordination of Benefits (PDF) Jun. 2017
Drug Policy Aug. 2017
Home Health Supplies (PDF) Jun. 2017
Vitamin and Mineral Products (PDF) Jun. 2017
Drug Utilization Review (PDF) Jun. 2017
Prior Authorization (PDF) Jan. 2017
Drug Pricing & Reimbursement (PDF) May 2017
Health Resources Services Administration (PDF) May 2017
Pharmacy Payment (PDF) Jun. 2017
Pharmacy Audits (PDF) Jun. 2017
Drug Rebates (PDF) Jun. 2017

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.