August 25, 2017

Page revised Nov. 21, 2017.

On Aug. 25, Hurricane Harvey hit the Texas coast and caused significant damage and flooding in numerous counties forcing many to evacuate to temporary locations.

Updates from Texas HHS:

Updates from VDP:

County Disaster Proclamations  (gov.texas.gov):

Pharmacy Instructions

Traditional Medicaid

People often forget their medicines when they evacuate and need an early refill from a pharmacy. Texas HHS is implementing an emergency procedure for you to follow if a prescription claim rejects with error code 79 (“Refill Too Soon") or 76 (“Plan Limitations Exceeded”). You can override error codes 79 or 76, but only for people pharmacies identify as affected by Hurricane Harvey and for replacement medications lost or left behind. Pharmacy staff should use their professional judgment when filling prescriptions to ensure adherence to state and federal law.

Segment Field Number Field Name Value
Claim 461-EU Prior Authorization Type Code 9 (“Emergency Preparedness”)
Claim 462-EV Prior Authorization Number Submitted 82Ø17

This emergency override procedure is available as of 7 p.m. Central Time on Friday, Aug. 25, and available for claims with service dates of Aug. 24 forward. The emergency override will be in place as long as necessary.

Managed Care

For people enrolled with Medicaid managed care or CHIP, pharmacy staff should contact the person’s managed care organization for instruction and guidance. Pharmacy staff can download the Pharmacy Assistance Chart (PDF) to identify pharmacy call centers for each MCO.

Eligibility Verification Methods

Pharmacy staff who are unsure which MCO a Medicaid- or CHIP-eligible person is enrolled with can use one of the two VDP real-time eligibility verification tools for clarification:

  • The NCPDP Eligibility Verification (E1) Transaction submitted through the pharmacy’s point-of-sale system.
  • The Pharmacy Eligibility Verification Portal (EVP) is a browser-based application that is free for all pharmacy providers enrolled with VDP.

If pharmacy staff does not know the person’s Cardholder ID, they can submit the person’s social security number preceded by an S (e.g., “S123456798”) to receive the person’s Cardholder ID on the returned response. When pharmacy staff submit the Cardholder ID they receive the following information:

  • The most current or last effective eligibility period (pertaining to the date submitted).
  • The client’s prescription limitations, if any.
  • Whether or not the client had periods of prior eligibility.
  • Whether or not the recipient is enrolled in a secondary program (such as CSHCN).

Please refer to the payer sheets for the E1 transaction and EVP accepted responses. If you have questions about how to submit an E1 transaction from your store, please contact your software provider.

The Your Texas Benefits Provider Help Desk

Pharmacy staff can call 1-855-827-3747 and select Option 3 and follow the applicable prompts. Please have the Medicaid or CHIP cardholder ID and date of birth ready to expedite your call.

Additional Information