Pharmacy Provider Procedure Manual

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.

Chapter Month Revised
Introduction (PDF) Mar. 2018
Contact Information (PDF) Mar. 2018
Enrollment (PDF) Feb. 2018
Managed Care (PDF) Nov. 2017
System Requirements (PDF) Nov. 2017
Eligibility (PDF) Nov. 2017
Coordination of Benefits (PDF) Feb. 2018
Drug Policy Mar. 2018
Home Health Supplies (PDF) Nov. 2017
Vitamin and Mineral Products (PDF) Nov. 2017
Drug Utilization Review (PDF) Nov. 2017
Prior Authorization (PDF) Feb. 2018
Pricing & Reimbursement (PDF) Mar. 2018
Health Resources Services Administration (PDF) Mar. 2018
Payment (PDF) Nov. 2017
Audits (PDF) Nov. 2017
Drug Rebates (PDF) Mar. 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.