Pharmacy providers must be enrolled with the Vendor Drug Program prior to providing outpatient prescription services and prior to participating in any Medicaid managed care network as a pharmacy provider. Managed care organizations must allow any pharmacy provider willing to accept the terms and conditions of the MCO/PBM contract to enroll in their network. To participate in the Medicaid or CHIP managed care networks the pharmacy must contact the individual managed care health plans.
Pharmacy staff must contact HHSC to enroll or to notify of any changes in your pharmacy enrollment.
Prescribing physicians do not enroll with the Vendor Drug Program but demographic data about prescribers is received monthly from various state licensing bodies. This information is loaded into the VDP claims system and used in the adjudication process. The following provider types are loaded:
- Medical doctors (MD)
- Doctor of Dental Surgery (DDS)
- Doctor of Osteopathic Medicine (DO)
- Doctor of Podiatry (DP & DPM)
- Advanced Practice Registered Nurses (APRN)
- Prescribing Pharmacist (PH)
- Physician Assistants (PA)
- Therapeutic Optometrist & Glaucoma Specialist (OD & OGD)
If the prescribing provider's National Provider Identifier (NPI) is not on file with VDP then users may query the NPI Registry. Pharmacy staff can contact VDP to have the NPI added and allow claims to process.