CMS sends Texas quarterly updates to the Unit Rebate Amounts (URA) for each manufacturer, approximately forty-five days after the end of the calendar year quarter. URAs are computed by CMS based on information submitted by manufacturers. The Texas VDP rebate system loads all drug data and manufacturer information from CMS.
HHSC computes URAs for the CHIP, CSHCN, HTW, and KHC programs separately, and loads the information into the rebate system from separate files.
HHSC invoices manufacturers for rebates on all fee-for-service (FFS) claims and managed care encounters loaded into the rebate system every quarter. CMS requires the generation and transmission of federal rebate invoices within 60 days after the end of each calendar quarter. Supplemental rebate invoices are generated and transmitted 75 days after the end of each calendar quarter.
Drug rebate invoices are calculated based on 11-digit NDCs, drug quantity units on paid claims (original, coordinated, and adjusted claims), URA, interest owed, and prior period adjustments (PPA). Manufacturers request claim level detail to confirm utilization by contacting Conduent State Healthcare, the HHSC pharmacy claims and rebate administration vendor, at PCRA_CLDandDisputes@Conduent.com.
An invoice is created for each program. Applicable program names and descriptions are included in the title of the invoice. Refer to the list of program names (as of Sept. 1, 2020).
| Program Name | Program Description |
|---|---|
| TXMED | Fee-for-Service Medicaid pharmacy claims |
| TXSUPP | Supplemental Fee-for-Service Medicaid pharmacy claims |
| TXEFMAP | Fee-for-Service Medicaid pharmacy claims based on special grant requirements |
| TXEFMAPSUP | Supplemental fee-for-service Medicaid pharmacy claims based on special grant requirements |
| TXMCO | Managed care Medicaid pharmacy claims |
| TXMCOSUP | Supplemental Medicaid managed care pharmacy claims |
| TXMCOEFMAP | Managed care Medicaid pharmacy claims based on special grant requirements |
| TXMCOEFMAPSUP | Supplemental Medicaid managed care pharmacy claims based on special grant requirements |
| TXJCODE | Drugs extracted from fee-for-service Medicaid medical claims |
| TXMCOJCOD | Drugs extracted from Medicaid managed care medical claims |
| TXEFMAPJCOD | Drugs extracted from Medicaid Fee-for-service Medical Claims based on Special Grant Requirements |
| TXMCOEFMAPJC | Drugs extracted from Medicaid managed care medical claims based on special grant requirements |
| CNSF | Children’s Health Insurance Program (CHIP) Not State Funded |
| BCCP | Fee-for-service breast and cervical cancer pharmacy claims |
| KHC | Kidney Health Care Program |
| CSHCN | Children with Special Health Care Needs Services Program |
| TWHP | Texas Women’s Health Program. The state-funded portion of the Healthy Texas Women’s Program serving women under 18 years. |
| TXMCOBCCP | TXMCOBCCP |
| HTW | Healthy Texas Women Program. The federally funded portion of the Healthy Texas Women’s Program subject to CMS rebate rules serving women 18 years and older. |