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.

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.

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.

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.

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.

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.