Texas pharmacies that want to participate in Texas Medicaid must enroll with the Vendor Drug Program prior to providing outpatient prescription services:
- Enrollment will be effective the date the Pharmacy Provider Agreement is executed by HHSC, and will not be back-dated.
- Pharmacies can only submit claims for prescriptions filled on or after the effective date of enrollment.
- Enrollment as a Medicaid provider is a prerequisite for participation in any program administered by VDP, including managed care.
- Enrollment will be terminated for pharmacies that have been inactive (had no claim payment) within a continuous twelve-month period. If an enrollment is terminated because of inactivity, the pharmacy must reapply to the Vendor Drug Program by submitting a new application for reinstatement.
Any provider performing medical services that wish to be eligible for reimbursement for Title XIX (Medicaid) benefits must contact the Texas Medicaid & Healthcare Partnership (TMHP). To enroll, complete an application from the TMHP Provider Enrollment website. For further assistance about completing the application contact the TMHP Contact Center at 1-800-925-9126, or visit the TMHP Regional Support website to find contact information for the local TMHP provider relations representative in your area.
HHSC requires application fees for pharmacies enrolling in Texas Medicaid in accordance with federal guidelines. Each year the Centers of Medicare and Medicaid Services publishes the application fee in the Federal Register prior to the fee being effective for the new calendar year, and the amount of the application fee is subject to change every year. Pharmacies participating in Medicare or Medicaid in another state may submit proof of payment of the application fee to satisfy the application fee requirement in Texas Medicaid.
- The fee is $569.00 for applications submitted between Jan. 1 and Dec. 31, 2018.
- The fee is $586.00 for applications submitted between Jan. 1 and Dec. 31, 2019.
Maintaining Your Enrollment
In accordance with the terms and conditions of enrollment, all pharmacies must notify Texas Medicaid in writing of any changes of the following:
- Billing and/or physical addresses
- Phone and fax numbers
- Key personnel (i.e. owners, control interests, pharmacists)
- Financial information (i.e. direct deposit)
- Store closure
Please refer to your Agreement for all requirements of enrollment update submissions. Pharmacies can verify information via the pharmacy search. If the information is incorrect or incomplete, you run the risk of not receiving correspondence from Texas HHS. Failure to update your enrollment information could result in your claims being placed on vendor hold or the termination of your enrollment. Please submit corrections via fax on your pharmacy letterhead.