Formulary Drug File Layout
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 |
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|
| 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 |
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|
| 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