Pharmacists may administer long-acting injectable (LAI) antipsychotics and opioid antagonists to treat a substance or opioid use disorder in a pharmacy setting for people in Medicaid with a valid prescription. Pharmacists can administer medications under a physician's delegation as authorized by state law. Refer to Texas Occupation Code section 554.004 (Administration of Medication). Refer to the Formulary search to identify drugs eligible for administration in a pharmacy.
The pharmacy, not the pharmacist, submits claims for these services using the standard pharmacy claim transaction and is reimbursed for an ingredient cost, dispensing fee, and administration fee for each LAI claim processed. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.
Administering pharmacists are health care professionals licensed by the TSBP to practice as a pharmacist, have met and maintained the eligibility requirements outlined in the law, and are under the supervision of a physician. Pharmacists are employed and remunerated by a pharmacy for their services. If the program's services are covered and reimbursable, payment may be made to the pharmacy employing the licensed pharmacist.
Medicaid managed care
The pharmacy benefit allows pharmacists to administer long-acting injectable antipsychotics and opioid antagonists to treat a substance use disorder or opioid use disorder. MCOs must reimburse pharmacies for the ingredient cost, dispensing fee, and applicable administration fees for certain long-acting anti-psychotics, opiate dependence treatments, and emergency treatment for known or suspected opioid overdoses. Pharmacy providers should contact the client's specific MCO for details.