Reimbursement and Payment

Fee Schedule

Texas Medicaid reimburses contracted pharmacy providers according to the “Pharmacy (Non-DME)” fee schedule. The estimated acquisition cost is defined in the Texas Administrative Code Title 1, Section 355.8541 relating to Legend and Non-legend Medication. To learn more about reimbursement refer to the Pricing and Reimbursement chapter of the Pharmacy Provider Procedure Manual.

Payment Cycle

Refer to the Payment chapter of the Pharmacy Provider Procedure Manual for information about the payment cycle.

Payment Files

Refer to the Payment chapter of the Pharmacy Provider Procedure Manual for information about weekly payment files.

Payment Delays

Refer to the Payment chapter of the Pharmacy Provider Procedure Manual for information about payment delays.

Direct Deposit

Pharmacy staff must complete the Direct Deposit Authorization (CPA Form 74-176) to receive weekly payments through direct deposit. The form is also used to change bank information, such as financial institution, account number, or cancellation of account. An account change will result in the pharmacy provider receiving paper warrants until the process is completed. Completed forms should be sent to HHSC.

Pharmacy Refunds

Refer to the Payment chapter of the Pharmacy Provider Procedure Manual for information about refunds.

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