Most people enrolled in Medicaid, and all people enrolled in the Children's Health Insurance Program, receive prescription drug benefits through the managed care delivery model.
To receive federal funds for outpatient prescription claims, all drugs on the Texas Medicaid formulary must be made by a drug manufacturer that participates in the CMS Drug Rebate Program. In return for having their drugs covered by state Medicaid programs, the manufacturer agrees to pay rebates according to their state and federal contracts. Funds received from manufacturers through rebate programs supplement Medicaid funds from both the federal and state governments and offset Medicaid costs.
Drug Utilization Review Board
The Texas Drug Utilization Review Board meets quarterly in Austin to develop criteria and standards impacting the Texas Medicaid formulary. The board also develops recommendations for the Texas preferred drug list, suggests clinical prior authorizations for outpatient prescription drugs, recommends educational interventions for Medicaid providers, and reviews drug utilization across Medicaid.
The website includes a collection of reports about the Medicaid outpatient pharmacy benefit.
The website maintains a running list of files and documents.