VDP Website Handbook

Last Updated

W-1. About

The Texas Vendor Drug Program website (https://www.txvendordrug.com) includes several resources and references for stakeholders. Many are updated regularly and can resolve issues or prevent the need for a phone call to the help desk or emailing HHSC. This manual provides guidance and instruction on viewing or downloading manuals, forms, and delimited data files.

Copyright Acknowledgments

Microsoft Corporation requires the following notice in publications containing trademarked product names: "Microsoft® and Windows® are either registered trademarks or trademarks of Microsoft Corporation in the United States and other countries."

W-2. Manuals

HHSC publishes the following manuals as HTML. You can print or download a copy of all or portions of the manual by clicking the "printer-friendly version" link on any manual page. The link presents the content only within the immediate section or chapter. To download the complete manual, users must click the "printer-friendly version" link on the manual's home page.

Gainwell Technologies is the pharmacy benefits administrator for VDP and publishes the following manuals on our behalf. Links to these manuals are available at txvendordrug.com/resources/manuals.

  • VDP Electronic Certificate of Information (ECOI) User Guide
  • VDP Payer Specifications
  • VDP Provider Portal Registration User Guide
  • VDP Provider Portal User Guide
  • VDP Prior Authorization Manual for Providers
  • VDP Learning Management System (LMS) Registration Guide

W-3. Forms

HHSC uses forms for pharmacy enrollment, registering for special system access, requesting prior authorization for drugs, and conducting other business.

  • Refer to the HHSC Forms Directory at hhs.texas.gov/laws-regulations/forms for many numbered HHSC forms.
  • Refer to the VDP website Downloads page (txvendordrug.com/resources/downloads) for links to all forms. Each form has unique completion and submission instructions.
  • Some forms cannot be viewed in a web browser and must be opened in Adobe Reader on your desktop system. Refer to the HHSC File Viewing Information at hhs.texas.gov/file-viewing-information for solutions to common problems, including disabling your web browser's built-in PDF viewer and instructions on downloading forms to your computer.

W-4. Searches

HHSC publishes several databases to allow users to search resource data, such as pharmacies, drugs, and prescribing providers.

Sometimes web browsers show old data in search results. To ensure that your browser shows the current version of a page, hold the shift key down on the keyboard and, at the same time, use the mouse to click the refresh or reload icon of your browser. This action forces the browser to download the latest version of the data.

The content of each database is available to download as a delimited text file. Refer to the Data Files section of this manual for instructions on downloading and reading the files.

Contact us if the search is unavailable or for questions about the data.

Clinician-Administered Drug Search

The clinician-administered drug database file contains all clinician-administered drugs available in Medicaid. HHSC updates the database quarterly.

Users can search the database by submitting a combination of the following fields:

  • Drug Name
  • 11-digit NDC number
  • 5-character Healthcare Common Procedure Coding System (HCPCS) code
  • HCPCS Description
  • Relation start and end dates, relating to the association between the HCPCS and NDC

The search results return the drug name and NDC, HCPCS code and description, and the HCPCS-NDC relation dates.

Users can click the hyperlink in the Name/NDC field for more information about the drug, including conversion factor.

Formulary Drug Search

The formulary drug database file contains all drugs available in Medicaid, CHIP, and other state programs. HHSC updates the database weekly.

Users can search the database by submitting a combination of the following fields:

  • Drug name
  • 11-digit NDC
  • Manufacturer name
  • Preferred drug class
  • Clinical prior authorizations name

Users can also filter findings by selecting the following:

  • By program
    • Medicaid
    • CHIP
    • CSHCN
    • HTW
    • HTW-Plus
    • KHC
  • By identifiers
    • All drugs requiring non-preferred prior authorization
    • All drugs requiring clinical prior authorization in fee-for-service Medicaid
    • All family planning drugs
    • All drugs requiring 90% use before a refill
    • All over-the-counter drugs
    • All injectable drugs
    • All Medicare Part B cost-share drugs
    • All Medicare Part D wrap-around drugs
    • All long-acting reversible contraception drugs

The search results return the brand and generic name of the drug, the NDC and manufacturer name, PDL class name, identifiers for PDL and traditional Medicaid clinical prior authorization requirements, and the name of state programs in which the drug is allowed. Users can click the hyperlink in the Brand Name/Generic Name column for more details.

The drug details include general drug information, fee-for-service pricing, and program coverage. Drugs requiring fee-for-service clinical prior authorization include a link to the prior authorization criteria document.

A drug with a termination date will appear on the search for 90 days following the termination date.

Formulary Product Search

The formulary product database file contains supplies and other non-drug items on state program formularies. HHSC updates the database weekly.

Users can search the database by submitting a combination of the following fields:

  • Drug name
  • 11-digit NDC
  • Manufacturer name
  • Product description

Users can also filter findings by selecting the following:

  • By program
    • Medicaid
    • CHIP
    • CSHCN
    • KHC
  • By type of product
    • All COVID-19 test kits
    • All COVID-19 vaccines
    • All diabetic supplies
    • All influenza vaccines
    • All Medicare Part B cost-share products
    • All Medicare Part D wrap-around products
    • All mosquito repellents
    • All vitamins and minerals

The search results return the product name, the NDC and manufacturer name, package size, and the name of state programs in which the product is allowed. Users can click the hyperlink in the Name column for more details.

The product details include general product information, fee-for-service pricing, and program coverage.

A product with a termination date will appear on the search for 90 days following the termination date.

Managed Care Organization Resources Search

The Managed Care Organization (MCO) Resources search database file contains pharmacy-related information pertaining to all HHSC-contracted MCOs. HHSC updates the database weekly.

Users can search the database by submitting a combination of the following fields:

  • MCO name
  • Program name (i.e., STAR, CHIP, STAR-PLUS, etc.)
  • Service area (location)
  • Pharmacy benefit manager (PBM) name

The search results return the above four fields with all records meeting your search criteria. Users can click the hyperlink in the MCO Name column for more details.

The search details include the following information:

  • MCO name
  • Service area
  • Program
  • PBM name and effective date
  • How to contact the MCO to enroll as a pharmacy and durable medical equipment provider
  • Pharmacy, member, and prior authorization call center phone numbers
  • Pharmacy claims billing information (BIN, PCN, and Group ID fields)
  • Links to MCO websites

Each MCO reports its information to HHSC. Contact the MCO for further details or questions about submitting claims to that MCO.

Pharmacy Search

The pharmacy database file contains all pharmacies enrolled in Medicaid. HHSC updates the database weekly.

Users can search the database by submitting a combination of the following fields:

  • 10-digit NPI number
  • 6-digit vendor ID number
  • Pharmacy name
  • Pharmacy address (search by street, city, ZIP code, or county)
  • HHSC region

Users can also filter findings by selecting the following:

  • Delivery pharmacies
  • Mail-order pharmacies

The search results return the NPI and vendor ID numbers, pharmacy name, address, phone number, and the state programs in which the pharmacy participates.

Users can click the hyperlink in the pharmacy name field for more information about the pharmacy.

Prescriber Search

The prescriber database file contains all prescribing providers enrolled in Medicaid. HHSC updates the database weekly.

Users can search the database by submitting a combination of the following fields:

  • 10-digit NPI number
  • State license number
  • Prescriber name
  • Pharmacy address (search by street, city, ZIP code, or county)
  • Prescriber type
  • Prescriber specialty type

The search results return the prescriber name, specialty, NPI and state license, and address (street, city, state, and ZIP code).

Users can click the hyperlink in the prescriber name field for more information about the prescriber.

W-5. Data Files

HHSC provides data files for use by the public. Each data file has an associated layout document, which identifies the fields and formatting within each file. Refer to the VDP website Data Files page (txvendordrug.com/resources/data-files) for the list of delimited files.

HHSC presents many of the files in a delimited format. Users must parse, or translate, the file to make the contents readable. The first line of each file contains headers, and each subsequent line is a row of data. Each data file has the following specifications:

  • Separates the data in each row by a vertical bar (|)
  • Encloses values between double quotes if present, but double quotes are not applied to fields when no character value exists
  • Does not populate null values with spaces

You must download and save the file to your computer before opening it.

Clinical Prior Authorization File Layout

Last Updated

This layout document contains all drugs on the Medicaid formulary with clinical prior authorization criteria requirements for traditional Medicaid. HHSC updates the database weekly. Data from the file appears on the formulary drug search.

Field Name Description Length Format Note
Drug_NDC Identifies the 11-digit National Drug Code (NDC) number 11    
Drug_cpa_description Identifies the clinical prior authorization criteria name 100    
Drug_cpa_url Identifies the hyperlink to the clinical prior authorization criteria document 150    
Drug_cpa_EffDate Identifies the clinical prior authorization criteria effective date 10 MM/DD/CCYY  
Drug_cpa_EndDate Identifies the clinical prior authorization criteria termination date 10 MM/DD/CCYY  

Clinician-administered Drug File Layout

Last Updated

This layout document describes the fields in the clinician-administered drug search data file.

Field Name Description Length Format Note
CAD_NDC Identifies the 11-digit National Drug Code (NDC) number 11    
CAD_NDC_MOD Identifies the 2-digit NDC modifier 2    
CAD_HCPCS_CODE Identifies the Healthcare Common Procedure Coding System code 6    
CAD_HCPCS_MOD_CODE Identifies the 2-digit HCPCS code modifier 2    
CAD_RELATION_START_DATE Identifies the NDC relationship start date 10 MM/DD/YYYY  
CAD_RELATION_END_DATE Identifies the NDC relationship termination date 10 MM/DD/YYYY Open-ended date = 12/31/3999
CAD_HCPCS_DESCRIPTION Identifies the HCPCS description 100    
CAD_NDC_LABEL Identifies the First Databank (FDB) label name of the drug 100    
CAD_NDC_PKG_SIZE_QTY Identifies the NDC package size quantity 13 ZZZZZZ.99999  
CAD_NDC_PKG_SIZE_MEASURE Identifies the NDC package size measurement 2  
  • F2 (International unit)
  • GR (Gram)
  • ML (Milliliter)
  • UN (Unit)
CAD_NDC_PKG_TYPE_MEASURE Identifies the NDC package type measurement 2    
CAD_ROUTE_OF_ADMINISTRATION Identifies the NDC route of administration 2    
CAD_BILLING_UNITS Identifies the NDC billing units 2    
CAD_CONVERSION_FACTOR Identifies the NDC conversion factor 13    
CAD_EFFECTIVE_DATE Identifies the NDC effective date 10 MM/DD/YYYY  
CAD_END_DATE Identifies the NDC termination date 10 MM/DD/YYYY Open-ended date = 12/31/3999
CAD_NDC_PRIOR_EFF_DATE_2 Identifies the #2 prior NDC effective date 10 MM/DD/YYYY  
CAD_NDC_PRIOR_END_DATE_2 Identifies the #2 prior NDC termination date 10 MM/DD/YYYY  
CAD_PRIOR_CF_2 Identifies the #2 prior NDC conversion factor 13    
CAD_NDC_PRIOR_EFF_DATE_3 Identifies the #3 prior NDC effective date 10 MM/DD/YYYY  
CAD_NDC_PRIOR_END_DATE_3 Identifies the #3 prior NDC termination date 10 MM/DD/YYYY  
CAD_PRIOR_CF_3 Identifies the #3 prior NDC conversion factor 13    

Formulary Drug File Layout

Last Updated

This layout document describes the fields in the formulary drug search data file.

Field Name Description Length Format Note
Drug_Generic Identifies the generic name of drug 35    
Drug_HTW_code Identifies whether the drug is active on Healthy Texas Women (HTW) Program formulary 3    
Drug_limit_fp Identifies whether the drug is a family planning drug 3    
Drug_limit_ds Identifies whether the drug is a diabetic supply drug 3    
Drug_limit_ppg Identifies whether the drug has premium preferred generic (PPG) pricing 3    
Drug_limit_ppg Identifies the refill utilization percentage 3   Refer to the Refill Utilization section of the pharmacy manual for more information
Drug_NDC Identifies the 11-digit National Drug Code (NDC) number 11    
Drug_Descr Identifies the First Databank (FDB) label name of the drug 35    
Drug_Pkg Identifies the package size of the drug 12 ZZZZZZ.99999  
Drug_Unit Identifies the unit of measure of the drug 2  
  • GM = Gram
  • ML - Milliliter
  • EA = Each
Drug_340B Identifies the Texas reimbursement rate for 340B drugs 14 ZZZZZZ.99999  
Drug_med_EffDate Identifies the effective date of the drug on Medicaid formulary 10 MM/DD/CCYY  
Drug_med_EndDate Identifies the termination date of the drug on the Medicaid formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_Med_Code Identifies whether the drug is active on the Medicaid formulary 3    
Drug_CMP_V Identifies whether the drug is only available for multi-ingredient compound Medicaid claims 3    
Drug_Med_Comment Identifies any paper prior authorization form requirements for drugs on the Medicaid formulary 60    
Drug_chip_EffDate Identifies the effective date of the drug on CHIP formulary 10 MM/DD/CCYY  
Drug_chip_EndDate Identifies the termination date of the drug on the CHIP formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_chip_code Identifies whether the drug is active on the CHIP formulary 3    
Drug_CMP_P Identifies whether the drug is only available for multi-ingredient compound CHIP claims 3    
Drug_cshcn_EffDate Identifies the effective date of the drug on the CSHCN formulary 10 MM/DD/CCYY  
Drug_cshcn_EndDate Identifies the termination date of the drug on the CSHCN formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_cshcn_code Identifies whether the drug is active on the CSHCN formulary 3    
Drug_CMP_C Identifies whether the drug is only available for multi-ingredient compound CSHCN claims 3    
Drug_cshcn_comment Identifies any paper prior authorization form requirements for drugs on the CSHCN formulary 60    
Drug_khc_EffDate Identifies the effective date of the drug on the KHC formulary 10 MM/DD/CCYY  
Drug_KHC_EndDate Identifies the termination date of the drug on the KHC formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_khc_code Identifies whether the drug is active on the KHC formulary 3    
Drug_CMP_K Identifies whether the drug is only available for multi-ingredient compound KHC claims 3    
Drug_htw_EffDate Identifies the effective date of the drug on the HTW formulary 10 MM/DD/CCYY  
Drug_htw_EndDate Identifies the termination date of the drug on the HTW formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_legend_status Identifies whether the drug is legend or over-the-counter 21  
  • Over the counter
  • Prescription required
Drug_PDL_pa_required Identifies whether the drug requires a Medicaid non-preferred (PDL) prior authorization 3    
Drug_pdl_EffDate Identifies the effective date of the Medicaid non-preferred (PDL) prior authorization 10 MM/DD/CCYY  
Drug_MKID Identifies the drug's preferred prior authorization therapeutic class code 4   Refer to the valid values for the PDL therapeutic class description
Drug_Clinical_pa_required Identifies whether the drug requires a Medicaid clinical prior authorization 3    
Drug_Retail Identifies the current acquisition cost for VDP-identified retail pharmacies 14 ZZZZZZ.99999  
Drug_Retail_EffDate Identifies the effective date of the current acquisition cost for VDP-identified retail pharmacies 10 MM/DD/CCYY  
Drug_LTC Identifies the current acquisition cost for VDP-identified long-term care pharmacies 14 ZZZZZZ.99999  
Drug_LTC_EffDate Identifies the effective date of the current acquisition cost for VDP-identified long-term care pharmacies 10 MM/DD/CCYY  
Drug_SPC Identifies the current acquisition cost for VDP-identified specialty pharmacies 14 ZZZZZZ.99999  
Drug_SPC_EffDate

Identifies the effective date of the current acquisition cost for VDP-identified specialty  pharmacies

 10 MM/DD/CCYY  
Drug_VAC Identifies the current VDP acquisition cost when the drug does not have retail, LTC, or specialty pricing 14 ZZZZZZ.99999  
Drug_VAC_EffDate Identifies the effective date of the current VDP acquisition cost 10 MM/DD/CCYY  
Drug_MKID_Desc Identifies the drug's preferred prior authorization therapeutic class description 50   Refer to the valid values for the PDL therapeutic class description
ID Identifies the 11-digit National Drug Code (NDC) number 11    
Drug_med_EndReason Identifies the reason for the drug's termination from the Medicaid formulary 50    
Drug_chip_EndReason Identifies the reason for the drug's termination from the CHIP formulary 50    
Drug_cshcn_EndReason Identifies the reason for the drug's termination from the CSHCN formulary 50    
Drug_khc_EndReason Identifies the reason for the drug's termination from the KHC formulary 50    
Drug_limit_larc Identifies whether the drug is a long-acting reversible contraception drug 3    
Drug_limit_injection Identifies whether the drug is long-acting injectable or Vivitrol 3    
Drug_admin_fee Identifies the administration cost value 14 ZZZZZZ.99999  
Drug_manufacturer Identifies the name of the drug manufacturer 15    
Drug_HTWPLUS_code Identifies whether the drug is active on HTW Plus Program formulary 3    
Drug_htwplus_EffDate Identifies the effective date of the drug on the HTW Plus formulary 10 MM/DD/CCYY  
Drug_htwplus_EndDate Identifies the termination date of the drug on the HTW Plus formulary 10 MM/DD/CCYY A drug with a termination date will appear on the file for 90 days following the termination date
Drug_chip_comment Identifies any paper prior authorization form requirements for drugs on the CHIP formulary 60    
Drug_khc_comment Identifies any paper prior authorization form requirements for drugs on the KHC formulary 60    
Drug_medicare-B Identifies an NDC considered a Medicare Part B covered benefit for dual eligible clients. 3    
Drug_medicare-D Identifies an NDC considered a wrap-around drug for Medicare Part D dual-eligible clients. 3    
Drug_sdl_code Identifies an NDC included on the Specialty Drug List. 3    
Drug_sdl_EffDate Identifies the effective date of an NDC included on the Specialty Drug List. 10 MM/DD/CCYY  
Drug_sdl_EndDate Identifies the termination date of an NDC included on the Specialty Drug List. 10 MM/DD/CCYY  

Formulary Drug File Valid Values

PDL Therapeutic Class Description

  • 001 - H. PYLORI TREATMENT
  • 002 - OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS
  • 003 - BPH TREATMENTS
  • 004 - PLATELET AGGREGATION INHIBITORS
  • 006 - BLADDER RELAXANT PREPARATIONS
  • 007 - STIMULANTS AND RELATED AGENTS
  • 008 - ANTIDEPRESSANTS, SSRIs
  • 009 - HYPOGLYCEMICS, TZD
  • 010 - ULCERATIVE COLITIS AGENTS
  • 011 - ALZHEIMER'S AGENTS
  • 012 - HYPOGLYCEMICS, METFORMINS
  • 013 - OPHTHALMICS, ANTI-INFLAMMATORIES
  • 014 - GROWTH HORMONE
  • 015 - ANTIPARKINSON'S AGENTS
  • 017 - ANGIOTENSIN MODULATOR COMBINATIONS
  • 018 - MACROLIDES/KETOLIDES
  • 019 - INTRANASAL RHINITIS AGENTS
  • 021 - ANTIMIGRAINE AGENTS, TRIPTANS
  • 022 - HYPOGLYCEMICS, MEGLITINIDES
  • 023 - IMMUNE GLOBULINS
  • 025 - ANTIVIRALS, ORAL
  • 027 - ANTIPSYCHOTICS
  • 028 - FLUOROQUINOLONES, ORAL
  • 029 - HYPOGLYCEMICS, INSULIN AND RELATED AGENTS
  • 030 - ANTIHISTAMINES, MINIMALLY SEDATING
  • 031 - ANTIDEPRESSANTS, OTHER
  • 033 - GLUCOCORTICOIDS, INHALED
  • 034 - IMMUNOMODULATORS, ATOPIC DERMATITIS
  • 036 - OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS
  • 037 - BRONCHODILATORS, BETA AGONIST
  • 038 - ERYTHROPOIESIS STIMULATING PROTEINS
  • 040 - SMOKING CESSATION
  • 041 - N/A
  • 042 - LEUKOTRIENE MODIFIERS
  • 043 - MULTIPLE SCLEROSIS AGENTS
  • 045 - CALCIUM CHANNEL BLOCKERS
  • 046 - CEPHALOSPORINS AND RELATED ANTIBIOTICS
  • 047 - PROTON PUMP INHIBITORS
  • 050 - HYPOGLYCEMICS, SULFONYLUREAS
  • 051 - OTIC ANTIBIOTICS
  • 052 - PHOSPHATE BINDERS
  • 054 - SEDATIVE HYPNOTICS
  • 055 - LIPOTROPICS, OTHER
  • 056 - ANTICONVULSANTS
  • 058 - OPHTHALMIC ANTIBIOTICS
  • 059 - NSAIDS
  • 060 - BONE RESORPTION SUPPRESSION AND RELATED AGENTS
  • 061 - ANTIFUNGALS, TOPICAL
  • 062 - HYPOGLYCEMICS, ALPHA-GLUCOSIDASE INHIBITORS
  • 063 - LIPOTROPICS, STATINS
  • 064 - HEPATITIS C AGENTS
  • 066 - N/A
  • 067 - N/A
  • 068 - ANTICOAGULANTS
  • 069 - ANTIFUNGALS, ORAL
  • 070 - BETA-BLOCKERS
  • 071 - CYTOKINE AND CAM ANTAGONISTS
  • 084 - ANDROGENIC AGENTS
  • 085 - ANTIEMETIC/ANTIVERTIGO AGENTS
  • 086 - OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR
  • 088 - OPHTHALMICS, GLAUCOMA AGENTS
  • 090 - ANXIOLYTICS
  • 098 - COPD AGENTS
  • 104 - ACNE AGENTS, TOPICAL
  • 105 - HEMOPHILIA TREATMENT
  • 108 - PANCREATIC ENZYMES
  • 109 - ANALGESICS, NARCOTICS SHORT
  • 110 - ANALGESICS, NARCOTICS LONG
  • 111 - HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS
  • 113 - ANGIOTENSIN MODULATORS
  • 114 - ANTIBIOTICS, TOPICAL
  • 115 - ANTIBIOTICS, GI
  • 116 - SKELETAL MUSCLE RELAXANTS
  • 117 - ANALHESICS/ANESTHETICS, TOPICAL
  • 118 - STEROIDS, TOPICAL LOW
  • 119 - STEROIDS, TOPICAL MEDIUM
  • 120 - STEROIDS, TOPICAL HIGH
  • 121 - STEROIDS, TOPICAL VERY HIGH
  • 122 - ANTIPARASITICS, TOPICAL
  • 123 - ANTIVIRALS, TOPICAL
  • 124 - ANTIBIOTICS, VAGINAL
  • 136 - ANTIVIRALS, GENERAL
  • 144 - ACNE AGENTS, ORAL
  • 145 - OPIATE DEPENDENCE TREATMENTS
  • 146 - LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS
  • 148 - COLONY STIMULATING FACTORS
  • 150 - OTIC ANTI-INFECTIVES & ANESTHETICS
  • 151 - PROGESTATIONAL AGENTS
  • 166 - ANTIHYPERTENSIVES, SYMPATHOLYTICS
  • 168 - GLUCOCORTICOIDS, ORAL
  • 171 - PAH AGENTS, ORAL AND INHALED
  • 173 - ONCOLOGY, ORAL - HEMATOLOGIC
  • 179 - PEDIATRIC VITAMIN PREPARATIONS
  • 182 - COUGH AND COLD, COLD
  • 183 - COUGH AND COLD, NARCOTIC
  • 184 - COUGH AND COLD, NON-NARCOTIC
  • 197 - PROGESTINS FOR CACHEXIA
  • 198 - BILE SALTS
  • 206 - IMMUNOMODULATORS, ASTHMA
  • 209 - PENICILLINS
  • 213 - TETRACYCLINES
  • 215 - ANTIDEPRESSANTS, TRICYCLIC
  • 221 - ROSACEA AGENTS, TOPICAL
  • 227 - BONE RESORPTION INHIBITORS, IV
  • 229 - IMMUNOSUPPRESSIVES, ORAL
  • 231 - ANTIHYPERURICEMICS
  • 232 - NEUROPATHIC PAIN
  • 235 - THROMBOPOIESIS STIMULATING PROTEINS
  • 237 - HIV / AIDS
  • 238 - EPINEPHRINE, SELF-INJECTED
  • 239 - ONCOLOGY, ORAL - OTHER
  • 240 - ANTIBIOTICS, INHALED
  • 243 - PRENATAL VITAMINS
  • 501 - HAE TREATMENTS
  • 502 - ONCOLOGY, ORAL - BREAST
  • 506 - IRON, ORAL
  • 509 - FLUORIDE PREPARATIONS
  • 513 - RESTLESS LEGS SYNDROME
  • 534 - GI MOTILITY, CHRONIC
  • 535 - HYPOGLYCEMICS, SGLT2
  • 537 - ANTIMIGRAINE AGENTS, OTHER
  • 547 - ANTI-ALLERGENS, ORAL
  • 548 - ONCOLOGY, ORAL - RENAL CELL
  • 550 - ONCOLOGY, ORAL - PROSTATE
  • 551 - ONCOLOGY, ORAL - LUNG
  • 563 - ONCOLOGY, ORAL - SKIN
  • 570 - UREA CYCLE DISORDERS, ORAL
  • 572 - MOVEMENT DISORDERS
  • 574 - ANTIHISTAMINES, FIRST GENERATION
  • 580 - SICKLE CELL ANEMIA TREATMENTS
  • 583 - GLUCAGON AGENTS

Formulary Product File Layout

Last Updated

This layout document describes the fields in the formulary product search data file.

Field Name Description Length Format Note
Product_Generic Identifies the generic name of product 35    
Product_limit_ds Identifies whether the product is a diabetic supply 3    
Product_limit_vm Identifies whether the product is a vitamin or mineral 3    
Product_NDC Identifies the 11-digit National Drug Code (NDC) number 11    
Product_Descr Identifies the First Databank (FDB) label name of the product 35    
Product_Pkg Identifies the package size of the product   ZZZZZZ.99999  
Product_Unit Identifies the unit of measure of the product 2  
  • GM = Gram
  • ML - Milliliter
  • EA = Each
Product_price Identifies the current product price 14 ZZZZZZ.99999  
Product_med_EffDate Identifies the effective date of the product on the Medicaid formulary 10 MM/DD/CCYY  
Product_med_EndDate Identifies the termination date of the product on the Medicaid formulary 10 MM/DD/CCYY A product with a termination date will appear on the file for 90 days following the termination date
Product_Med_Code Identifies whether the product is active on the Medicaid formulary 3    
Product_chip_EffDate Identifies the effective date of the product on the CHIP formulary 10 MM/DD/CCYY  
Product_chip_EndDate Identifies the termination date of the product on the CHIP formulary 10 MM/DD/CCYY A product with a termination date will appear on the file for 90 days following the termination date
Product_chip_code Identifies whether the product is active on the CHIP formulary 3    
Product_cshcn_EffDate Identifies the effective date of the product on the CSHCN formulary 10 MM/DD/CCYY  
Product_cshcn_EndDate Identifies the termination date of the product on the CSHCN formulary 10 MM/DD/CCYY A product with a termination date will appear on the file for 90 days following the termination date
Product_cshcn_code Identifies whether the product is active on the CSHCN formulary 3    
Product_khc_EffDate Identifies the effective date of the product on the KHC formulary 10 MM/DD/CCYY  
Product_khc_EndDate Identifies the termination date of the product on the KHC formulary 10 MM/DD/CCYY A product with a termination date will appear on the file for 90 days following the termination date
Product_khc_code Identifies whether the product is active on the KHC formulary 3    
Product_legend_status Identifies whether the product is legend or over-the-counter 21  
  • Over the counter
  • Prescription required
Product_price_EffDate Identifies the effective date of the current product price 10 MM/DD/CCYY  
Product_HCPCS Identifies the Healthcare Common Procedure Coding System (HCPCS) code 5   Refer to the valid values for the HCPCS description
Product_HCPCS_Desc Identifies the Healthcare Common Procedure Coding System (HCPCS) description 50   Refer to the valid values for the HCPCS description
ID Identifies the 11-digit National Drug Code (NDC) number 11    
Product_med_EndReason Identifies the reason for the product's termination from the Medicaid formulary 50    
Product_chip_EndReason Identifies the reason for the product's termination from the CHIP formulary 50    
Product_cshcn_EndReason Identifies the reason for the product's termination from the CSHCN formulary 50    
Product_khc_EndReason Identifies the reason for the product's termination from the KHC formulary 50    
Product_limit_hhs Identifies whether the product is a home health supply 3    
Product_limit_flu Identifies whether the product is a influenza vaccine 3    
Product_admin_fee Identifies the administration cost value 14 ZZZZZZ.99999  
Product_manufacturer Identifies the name of the product manufacturer 15    
Product_limit_zika Identifies whether the product is a mosquito repellent 3    
Product_limt_covid Identifies whether the product is a COVID-19 vaccine 3    
Product_med_Comment Identifies any paper prior authorization form requirements for products on the Medicaid formulary 60    
Product_cshcn_comment Identifies any paper prior authorization form requirements for products on the CSHCN formulary 60    
Product_khc_comment Identifies any paper prior authorization form requirements for products on the KHC formulary 60    
Product_chip_comment Identifies any paper prior authorization form requirements for products on the CHIP formulary 60    
Product_limit_ctk Identifies whether the product is a COVID-19 test kit 3    
Product_medicare-B Identifies an NDC considered a Medicare Part B covered service for dual eligible clients. 3    
Product_medicare-D Identifies an NDC considered a wrap-around service for Medicare Part D dual-eligible clients. 3    

Formulary Product File Valid Values

HCPCS Description

  • A4206 = Insulin Syringes
  • A4215 = Insulin Needles
  • A4253 = Diabetic Test Strips
  • A4258 = Spring Powered Device for Lancet
  • A4259 = Diabetic Lancets
  • A4627 = Aerosol Holding Chamber
  • A9275 = Diabetic Monitor & Test Strips
  • B4103 = Oral Electrolyte
  • E2100 = Diabetic Monitor (talking)
  • T1999 = Hypertonic Saline

Healthy Texas Women Program Formulary File Layout

Last Updated

This layout document describes the fields in the HTW Program Formulary file. The file contains all drugs on the Healthy Texas Women Program and Healthy Texas Women Plus Program formularies. The file contains two tabs, one for each program.

Field Name Description Length Format Note
Drug NDC Identifies the 11-digit National Drug Code (NDC) number 11    
Drug Name Identifies the name of the drug or product 35    
Drug Description Identifies the First Databank (FDB) label name of the drug or product 35    
Drug Package Size Identifies the package size of the drug 12    
Drug Unit Identifies the unit of measure of the drug 2  
  • EA = Each
  • GM = Gram
  • ML - Milliliter
Drug Legend Status Identifies whether the drug is legend or over-the-counter 10  
  • Non-Legend = Over the counter
  • Legend = Prescription required
Drug Effective Date Identifies the effective date of the drug on the HTW or HTW-Plus formulary 10 MM/DD/CCYY  
Drug End Date Identifies the termination date of the drug on the HTW or HTW-Plus formulary 10 MM/DD/CCYY  
Drug % Limit Refill Identifies the refill utilization percentage 3    
Market Basked Description Identifies the drug or product's market basket description 50  

Managed Care Resources File Layout

Last Updated

This layout document describes the fields in the managed care resource data file. HHSC updates the database weekly. Data from the file appears on the managed care resources search.

Field Name Description Length Format Note
MCO_PLAN_CD Identifies the 2-digit MCO plan code. 2    
MCO_FULL_NM Identifies the name of the MCO. 30   Refer to the valid values
MCO_SERVICE_AREA Identifies the service delivery area (SDA) of the MCO. 30   Refer to the valid values
MCO_PLAN_EFF_DT Identifies the MCO plan code effective date. 10 MM/DD/CCYY  
MCO_PLAN_TERM_DT Identifies the MCO plan code termination date. 10 MM/DD/CCYY  
MCO_PGM Identifies the MCO program name. 20   Refer to the valid values
MCO_PBM_NAME Identifies the name of the MCO’s pharmacy benefits manager. 35   Refer to the valid values
MCO_PLAN_RX_NUM Identifies the MCO’s 6-digit NCPDP Bank Identification Number (BIN). 6    
MCO_PLAN_PCN Identifies the MCO’s x-digit NCPDP Processor Control Number (PCN). 10    
MCO_PLAN_GRP Identifies the MCO’s NCPDP Group ID number(s). 500    
NOTE Identifies the additional information for the record. 1200    
MCO_PHARM_ENROLL_PH_NUM Identifies the MCO’s phone number for pharmacy enrollment. 12    
MCO_PHARM_ENROLL_PH_EXT Identifies the MCO’s phone number extension for pharmacy enrollment. 6    
MCO_PHARM_ENROLL_FAX_NUM Identifies the MCO’s fax number for pharmacy enrollment. 12    
MCO_PHARM_ENROLL_EMAIL Identifies the MCO’s email address for pharmacy enrollment. 100    
MCO_PHARM_ENROLL_WEB Identifies the MCO’s website for pharmacy enrollment. 255    
MCO_DME_ENROLL_PH_NUM Identifies the MCO’s phone number for durable medical equipment (DME) enrollment. 12    
MCO_DME_ENROLL_PH_EXT Identifies the MCO’s phone number extension for durable medical equipment (DME) enrollment. 6    
MCO_DME_ENROLL_FAX_NUM Identifies the MCO’s fax number for DME enrollment. 12    
MCO_DME_ENROLL_EMAIL Identifies the MCO’s email address for DME enrollment. 100    
MCO_DME_ENROLL_WEB Identifies the MCO’s website for DME enrollment. 255    
MCO_PHARM_PH_NUM Identifies the MCO’s pharmacy call center phone number. 12    
MCO_PHARM_PH_EXT Identifies the MCO’s pharmacy call center phone number extension. 6    
MCO_PA_PH_NUM Identifies the MCO’s prior authorization call center phone number. 12    
MCO_PA_PH_EXT Identifies the MCO’s prior authorization call center phone number extension. 6    
MCO_MEMBER_PH_NUM Identifies the MCO’s member call center phone number. 12    
MCO_MEMBER_PH_NUM_EXT Identifies the MCO’s member call center phone number extension. 6    
MCO_CPA_WEB Identifies the MCO’s clinical prior authorization website. 255    
MCO_C_PBM_EFF_DT Identifies the effective date of the MCO’s pharmacy benefits manager. 10 MM/DD/CCYY  
MCO_PHARM_PDL_WEB Identifies the MCO’s preferred drug list website. 4000    
MCO_PHARM_MANUAL_WEB Identifies the MCO’s pharmacy manual website. 4000    
MCO_PHARM_PAYER_SHEETS_WEB Identifies the MCO’s pharmacy payer sheets website. 4000    
MCO_PHARM_FORMS_WEB Identifies the MCO’s pharmacy forms website. 4000    
MCO_FORMULARY_WEB Identifies the MCO’s formulary website. 4000    

Managed Care Resources Valid Values

MCO Name

  • Aetna
  • Amerigroup Texas, Inc.
  • Blue Cross Blue Shield
  • Community First Health Plan
  • Community Health Choice
  • Cook Children's Health Plan
  • Dell Children's Health Plan
  • Driscoll Childrens Health Plan
  • El Paso First
  • FirstCare
  • HealthSpring
  • Molina Healthcare of Texas
  • Parkland Health Plan
  • Scott & White
  • Superior Health Plan
  • Texas Children's Health Plan
  • UnitedHealthcare

PBM Name

  • CVS/Caremark
  • Envolve Pharmacy Solutions
  • Express Scripts
  • IngenioRx
  • Navitus
  • Optum Rx
  • Prime Therapeutics

Program

  • CHIP
  • STAR
  • Star Health
  • STAR Kids
  • STAR+PLUS
  • STAR+PLUS MMP

Service Delivery Area

  • Bexar
  • CHIP RSA
  • Dallas
  • El Paso
  • Harris
  • Hidalgo
  • Jefferson
  • Lubbock
  • MRSA Central
  • MRSA Northeast
  • MRSA West
  • Nueces
  • Statewide
  • Tarrant
  • Travis

Non-risk-payment Drug File Layout

Last Updated

This layout document describes the fields in the non-risk-payment drug data file. The file contains all drugs the MCOs are responsible for providing through a non-risk, cost settlement basis. HHSC updates the database weekly. Data from the file does not appear in any search.

Field Name Description Length Format Note
NDC Identifies the 11-digit National Drug Code (NDC) number 11    
Drug_Name Identifies the drug name 35    
NRP_Eligibility_Begin_Date Identifies the non-risk-payment drug eligibility begin date 10 MM/DD/CCYY  
NRP_Eligibility_End_Date Identifies the non-risk-payment drug eligibility termination date 10 MM/DD/CCYY  
Drug_Type Identifies the drug type 9  
  • CAD
  • Formulary

Pharmacy File Layout

Last Updated

This layout document describes the fields in the pharmacy search data file.

Field Name Description Length Format Note
ID Identifies the 10-digit National Provider Identifier (NPI) 10    
Pharmacy_NPI Identifies the 10-digit NPI 10    
Pharmacy_Vendor_Number Identifies the 6-digit contract number assigned by HHSC 6    
Pharmacy_name Identifies the pharmacy's trade or doing-business-as name 25    
Pharmacy_alternate_Name Identifies the pharmacy's legal name 25    
Pharmacy_State_Lic Identifies the pharmacy's license number 6    
Pharmacy_Address Identifies the pharmacy's physical address (line #1) 25    
Pharmacy_Address2 Identifies the pharmacy's physical address (line #2) 25    
Pharmacy_City Identifies the pharmacy's physical address city 16    
Pharmacy_State Identifies the pharmacy's physical address state 2    
Pharmacy_Zip Identifies the pharmacy's physical address ZIP code 10 XXXXX-XXXX  
Pharmacy_region Identifies the HHSC region code of the pharmacy 2    
Pharmacy_Region_Cat Identifies the HHSC region code description 25   Refer to the valid values for pharmacy region description
Pharmacy_Subregion Identifies the HHSC-defined sub-region code 2   Refer to the valid values for pharmacy region description
Pharmacy_Subregion_Cat Identifies the HHSC-defined sub-region description 25   Refer to the valid values for pharmacy sub-region description
Pharmacy_County Identifies the 3-digit county code plus county name 20   Refer to the valid values for pharmacy sub-region description
Pharmacy_Phone_Number Identifies the pharmacy's physical address phone number 10 XXXXXXXXXX  
Pharmacy_khc Identifies whether the pharmacy is enrolled in the KHC Program 3    
Pharmacy_khc_EffDate Identifies the effective date of the pharmacy's enrollment in the KHC program 10 MM/DD/CCYY  
Pharmacy_khc_EndDate Identifies the termination date of the pharmacy's enrollment in the KHC program 10 MM/DD/CCYY  
Pharmacy_medicaid Identifies whether the pharmacy is enrolled in Medicaid 3    
Pharmacy_medicaid_EffDate Identifies the effective date of the pharmacy's enrollment in Medicaid 10 MM/DD/CCYY  
Pharmacy_medicaid_EndDate Identifies the termination date of the pharmacy's enrollment in Medicaid 10 MM/DD/CCYY  
Pharmacy_chip Identifies whether the pharmacy is enrolled in CHIP 3    
Pharmacy_chip_EffDate Identifies the effective date of the pharmacy's enrollment in CHIP 10 MM/DD/CCYY  
Pharmacy_chip_EndDate Identifies the termination date of the pharmacy's enrollment in CHIP 10 MM/DD/CCYY  
Pharmacy_cshcn Identifies whether the pharmacy is enrolled in the CSHCN Services Program 3    
Pharmacy_cshcn_EffDate Identifies the effective date of the pharmacy's enrollment in the CSHCN Services program 10 MM/DD/CCYY  
Pharmacy_cshcn_EndDate Identifies the termination date of the pharmacy's enrollment in the CSHCN program 10 MM/DD/CCYY  
Pharmacy_Delivers Identifies whether HHSC certified the pharmacy to provide free delivery service to Medicaid clients 3    
Pharmacy_htw Identifies whether the pharmacy is enrolled in the HTW program 3    
Pharmacy_htw_EffDate Identifies the effective date of the pharmacy's enrollment in the HTW program 10 MM/DD/CCYY  
Pharmacy_htw_EndDate Identifies the termination date of the pharmacy's enrollment in the HTW program 10 MM/DD/CCYY  
Pharmacy_Mail_order_identifier Identifies whether the dispenser type of pharmacy is mail order 3    
Pharmacy_Self_Reported_Type Identifies the type of pharmacy, self-reported at the time of its enrollment 20  
  • Retail
  • Long Term Care
  • Specialty
Pharmacy_340b Identifies whether pharmacy self-reported as 340B pharmacy at the time of its enrollment 3    

Pharmacy File Valid Values

Pharmacy Region Description

  • 0 = Out of State
  • 1 = High Plains
  • 2 = North West
  • 3 = Metroplex
  • 4 = Upper East Texas
  • 5 = South East Texas
  • 6 = Gulf Coast
  • 7 = Central Texas
  • 7 = Central Texas
  • 8 = Upper South Texas
  • 9 = West Texas
  • 10 = Upper Rio Grande
  • 11 = Lower South Texas

Pharmacy Sub-region Description

  • 0 = Out of State
  • 1 = Houston
  • 2 = Gilmer
  • 3 = Austin
  • 4 = West San Antonio
  • 5 = Fort Worth
  • 6 = Midland
  • 7 = Dallas
  • 8 = McAllen
  • 9 = Abilene
  • 10 = East San Antonio
  • 11 = Lubbock
  • 12 = South Fort Worth
  • 13 = Beaumont
  • 14 = North Houston

Prescriber File Layout

Last Updated

This layout document describes the fields in the prescriber search data file.

Field Name Description Length Format Note
Prescriber_VendorNumber License number 15    
Prescriber_NPI 10-digit National Provider Identifier (NPI) 10    
Prescriber_LastName Prescriber’s last name 22    
Prescriber_FirstName Prescriber’s first name 22    
prescriber_EffDate The effective date of prescriber’s license 10 MM/DD/CCYY  
Prescriber_TermDate The termination date of prescriber’s license 10 MM/DD/CCYY Open-ended date appears as null
Prescriber_Title 2-3–character degree code 3   Refer to the valid values for prescriber degree description
Prescriber_TitleDesc Degree description 50   Refer to the valid values for prescriber degree description
Prescriber_specialty 1-3–character specialty code 3   Refer to the valid values for prescriber specialty description
Prescriber_SpecialtyDesc Specialty description 50   Refer to the valid values for prescriber specialty description
Prescriber_Address The physical address of the prescriber (line #1) 30    
Prescriber_Address2 The physical address of the prescriber (line #2) 50    
Prescriber_City Physical address city 20    
Prescriber_State Physical address state (two-character abbreviation) 2    
Prescriber_Zip Prescriber address ZIP code 5    
Prescriber_certification_required Identifies whether the prescriber is required to certify to prescribe for HTW clients 3    
Prescriber_HTW_Certified Identifies whether the prescriber is certified to prescribe for HTW clients 3    
Prescriber_HTW_EffDate Identifies the effective date of the prescriber’s HTW certification 10 MM/DD/CCYY  
Prescriber_HTW_TermDate Identifies the termination date of the prescriber’s HTW certification 10 MM/DD/CCYY Open-ended date appears as null

Prescriber File Valid Values

Prescriber Degree Description

  • ANP = Advance Nurse Practitioner (Nursing Board)
  • DDS = Dentist (Dental Board)
  • DO = Osteopath / Individual (Medical Board)
  • DP = Podiatrist / Individual (Podiatry Board)
  • DPM = Podiatrist / Medical (Podiatry Board)
  • MD = Medical Doctor (Medical Board)
  • OD = Optometrist / Therapeutic (Optometry Board)
  • OGD = Optometrist / Therapeutic & Glaucoma Specialist (Optometry Board)
  • PA = Physician Assistant (Medical Board)
  • PH = Prescribing Pharmacist (Pharmacy Board)

Prescriber Specialty Description

  • A = Allergy
  • ABS = Abdominal surgery
  • ADL = Adolescent medicine
  • ADM = Administrative medicine
  • AI = Allergy and immunology
  • AM = Aerospace medicine
  • AN = Anesthesiology
  • BLB = Blood banking
  • CD = Cardiovascular diseases
  • CDS = Cardiovascular surgery
  • CHN = Child neurology
  • CHP = Child psychiatry
  • CLP = Clinical pathology
  • CRS = Colon and rectal surgery
  • D = Dermatology
  • DIA = Diabetes
  • DMP = Dermopathology
  • DR = Diagnostic radiology
  • EM = Emergency medicine
  • END = Endocrinology
  • ETX = Medical toxicology (emergency medicine)
  • FOP = Forensic pathology
  • FP = Family practice
  • FSM = Sports medicine (family practice)
  • FX = Flexible
  • GE = Gastroenterology
  • GEN = Genetics
  • GER = Geriatrics
  • GP = General practice
  • GPM = General preventive medicine
  • GS = General surgery
  • GYN = Gynecology
  • HEM = Hematology
  • HNS = Head and neck surgery
  • HS = Hand surgery
  • ID = Infectious diseases
  • IG = Immunology
  • IM = Internal medicine
  • LM = Legal medicine
  • MGP = Molecular genetic pathology
  • MT = Manipulative therapy
  • N = Neurology
  • NA = Neuropathology
  • NEP = Nephrology
  • NM = Nuclear medicine
  • NPM = Neonatal-perinatal medicine
  • NR = Nuclear radiology
  • NS = Neurological surgery
  • NTR = Nutrition
  • OBG = Obstetrics and gynecology
  • OBS = Obstetrics
  • OM = Occupational medicine
  • OMF = Oral & maxillofacial surgery
  • ON = Oncology
  • OPH = Ophthalmology
  • ORS = Orthopedic surgery
  • OS = Other specialty
  • OTO = Otolaryngology
  • P = Psychiatry
  • PA = Pharmacology, clinical
  • PD = Pediatrics
  • PDA = Pediatrics, Allergy
  • PDC = Pediatrics, Cardiology
  • PDE = Pediatric endocrinology
  • PDR = Pediatric radiology
  • PDS = Pediatric surgery
  • PH = Public health
  • PHO = Pediatric hematology/oncology
  • PM = Physical med. & rehabilitation
  • PS = Plastic surgery
  • PTH = Pathology
  • PUD = Pulmonary diseases
  • PYA = Psychoanalysis
  • R = Radiology
  • REN = Reproductive endocrinology
  • RHI = Rhinology
  • RHU = Rheumatology
  • RO = Radiation oncology
  • TR = Therapeutic radiology
  • TRS = Traumatic surgery
  • TS = Thoracic surgery
  • U = Urology
  • US = Unspecified
  • VS = Vascular surgery

W-5.2. Opening Data Files

You can use Microsoft Microsoft Excel® to open the file to make the content readable and sortable.

  1. Open Microsoft Excel®, select File, then Open, and then browse to the location containing the downloaded text file
  2. From the “File Type” dropdown list, select “Text Files”
  3. Locate and double-click the text file you want to open.
  4. The Text Import Wizard will open:
    1. Step 1:
      1. For original data type, select Delimited
      2. Click next
    2. Step 2:
      1. In the Delimiters section:
        1. Unselect the Tab check box.
        2. Select the Other check box
        3. Enter the pipe | character in the box to the right containing the cursor
      2. Click next
    3. Step 3:
      1. Click finish
  5. Go to File, Save As, and from the file type dropdown list, select “Excel Workbook”

W-6. Revision History

Status Date Description
Revision June 1, 2023 Added Managed Care Organization Resources Search and layout information
Revision July 1, 2022

Formulary Drug Search update: added clinical prior authorization and Medicare parts B and D search parameters

Formulary Product Search update: added Medicare parts B and D search parameters
Revision June 6, 2022

Formulary Drug File Layout update

Formulary Product File Layout update
Revision April 4, 2022 Clinical Prior Authorization File Layout update
Baseline March 1, 2022 Initial publication