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Downloads

Provider Enrollment and Management System Information

Pharmacy Enrollment

Managed Care

Formulary Resources

Drug Shortage Notification (HHS Form 1315)
Specialty Drugs
- Specialty drug process (PDF)
- Specialty drug submission spreadsheet (XLS)

Prior Authorization

Non-preferred
- Preferred Drug List
- PDL Criteria Guide (PDF)
Clinical
- Clinical PA Assistance Chart (PDF)
Forms
- Traditional Medicaid
- CSHCN Services Program
Texas Prior Authorization Call Center
- Registration
- Provider Quick Reference
- Texas Medicaid Prior Authorization Reconsideration Request (HHS Form 1322)

Manufacturer Resources

Manufacturer resources

Drug Utilization Review Board

Drug Utilization Review Board
- Meeting documents
- Drug utilization criteria/compendia

Education and Training Materials

Name	Revised
Dispensing 72-hour Emergency Prescriptions (PDF)	07/2019
Pharmacy Resources for Managed Care (PDF)	07/2019
Real-time Eligibility Verification (PDF)	07/2019
Mosquito Repellent Benefit (PDF)	07/2019

Claim Forms

Pharmacy Retroactive Claim Form (HHS Form 1318)
Pharmacy Claims Billing Request (HHS Form 1319)

Delimited Data Files

File	Layout File
Drug Index (TXT) †	Layout (PDF)
Product Index (TXT) †	Layout (PDF)
Clinical Prior Authorization Index (TXT) †	Layout (PDF)
Clinician-administered Drug Index (TXT) ‡	Layout (PDF)
HTW and HTW Plus Program (XLS) (Updated April 2021)	Layout (PDF)
Pharmacy Index (TXT) †	Layout (PDF)
Prescriber Index (ZIP) †	Layout (PDF)

† Denotes a weekly file last updated April 12.
‡ Denotes a quarterly file last updated April 12.