Pharmacy Enrollment
- Enrollment Forms
- Pharmacy Provider Procedure Manual
- Pharmacy Provider Payer Sheets
- Eligibility Verification
- Pharmacy Eligibility Verification Portal Access (HHS Form 1317)
- Pharmacy Payment
- Pharmacy Electronic Remittance Advice Agreement (HHS Form 1316)
Managed Care
- Pharmacy Enrollment Chart (PDF)
- Pharmacy Assistance Chart (PDF)
- Prescriber Assistance Chart (PDF)
- Service Delivery Area Assistance Chart (PDF)
Formulary Resources
- Drug Shortage Notification (HHS Form 1315)
- Specialty Drugs
- Clinician-administered Drugs
- Long-acting reversible contraception products
- Mosquito Repellent Benefit
Prior Authorization
- Non-preferred
- Clinical
- Forms
- Texas Prior Authorization Call Center
- Education
Manufacturer Resources
Drug Utilization Review Board
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
- † Denotes a weekly file last updated Jan. 19
- ‡ Denotes a quarterly file last updated Jan. 13