A pharmacy with a current license or registration with the Texas State Board of Pharmacy, or is licensed under the laws of another state and is free from any pharmacy board restriction, may apply to become a Texas Medicaid pharmacy provider. Pharmacies must enroll before providing outpatient Medicaid prescription services.
Pharmacies enroll using the Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS):
- The entire application process can typically take up to 60 business days after receiving all information necessary to process the application. TMHP may extend the timeline in particular circumstances. Requests for exceptions to the enrollment process, risk category, and provider types that require additional state approval may extend the length of the application process.
- TMHP sends pharmacies their enrollment effective dates in a confirmation email.
- Pharmacies can only submit claims on or after the enrollment date. Enrollment is not retroactive.
- HHSC requires pharmacy providers to enroll in Medicaid before participating in any other state program administered by HHSC or involvement in any Medicaid or CHIP MCO pharmacy network.
- HHSC will terminate pharmacies without claim payment within a continuous twelve-month period. The pharmacy must reapply by submitting a new application for reinstatement using PEMS.
- The fee for applications submitted between Jan. 1 and Dec. 31, 2021, is $599.00.
Providers performing medical services must enroll with Texas Medicaid for reimbursement for Title XIX (Medicaid) benefits. Refer to TMHP Provider Enrollment for an application. Refer to TMHP Provider Support Services to find contact information for TMHP provider relations representatives in your area.
Maintaining Your Enrollment
Pharmacies must notify Texas Medicaid of any changes of the following information using PEMS per the terms and conditions of enrollment:
- Billing and physical addresses
- Phone and fax numbers
- Key personnel (i.e., owners, control interests, pharmacists)
- Financial information, including direct deposit
- Store closure
Pharmacies can verify their information via the pharmacy search and should submit corrections through PEMS. If the information is incorrect or incomplete, you run the risk of not receiving correspondence from HHSC. Failure to update your enrollment information could result in claims being placed on vendor hold or the termination of your enrollment.