Pharmacy providers enrolled in Medicaid are uniquely positioned to help clients with their pharmacy benefits. Pharmacy providers need to know what pharmacy items Medicaid pays for, which products require prior authorization, and who to contact with questions about claim processing. HHSC provides the resources in this section to assist pharmacy providers in accomplishing this.
Continuing Education Modules
Texas Health Steps offers more than 40 continuing education courses accredited by the Accreditation Council of Pharmacy Education (ACPE). Pharmacy-related continuing education modules include the following:
- Pharmacy (txhealthsteps.com/493-pharmacy)
- This module equips pharmacists and pharmacy providers in delivering outpatient pharmacy services to people enrolled in Texas Medicaid, Children’s Health Insurance Program, Children with Special Health Care Needs Services Program, Healthy Texas Women Program, and Kidney Health Care Program.
HHSC encourages pharmacy providers to download the following materials, display them within the pharmacy, and reproduce them for internal education.
|Document Name||Revision Date|
|Dispensing 72-hour Emergency Prescriptions Instructions||July 2019|
|Find the Formulary on Epocrates||July 2022|
|Managed Care Complaint Process||May 2023|
|Medicaid Formulary Information||July 2022|
|Mosquito Repellent Benefit Information (for pharmacies)||May 2022|
|Mosquito Repellent Benefit Information (for clients) (English)||June 2022|
|Mosquito Repellent Benefit Information (for clients) (Spanish)||June 2022|
|Provider Enrollment and Management System||May 2022|
|Pharmacy Resources for Managed Care Information||May 2022|
|Real-time Eligibility Verification Information||July 2019|
Refer to the Education Documents to download these materials.
Texas Health Steps quick courses are short, targeted training modules. Most take 15 minutes or less to complete and do not offer continuing education credit. Pharmacy-related quick courses include the following:
- A Dispenser's Guide to Texas Medicaid Outpatient Pharmacy Benefits
- How to enroll and participate in the outpatient pharmacy program serving patients in fee-for-service Medicaid, Medicaid managed care, and various state health programs
- A Prescriber's Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization
- When and how to obtain prior authorization for outpatient prescriptions for patients enrolled in Texas Medicaid fee-for-service or managed care
- Texas Medicaid Mosquito Repellent Benefit: What Pharmacy Providers Need to Know
- How to dispense mosquito repellent year-round to eligible individuals using the state’s standing order or a valid prescription
TMHP Learning Management System
The TMHP Learning Management System is an education portal where all provider types can learn about Texas Medicaid. To access the LMS, providers must register and obtain a username. Refer to the LMS Registration and Navigation Job Aid to learn more about creating an account and navigating the LMS.
- TMHP LMS
- LMS Registration and Navigation Job Aid
Pharmacy-related computer-based training (CBT) modules include the following:
- Durable Medical Equipment
- The Pharmacy DME CBT provides DME and pharmacy DME providers information and resources necessary to enroll in Medicaid as a DME provider and provide DME and supplies to Medicaid clients.
- NDC Requirements for the Submission of Clinician-Administered Drug Claims
- Provides information about national drug code (NDC) and healthcare common procedure coding system (HCPCS) requirements on clinician-administered drug claims.
- Provider Enrollment and Management System (PEMS)
- The PEMS CBT modules present information about PEMS and the different types of provider enrollment applications.