Pharmacy Enrollment

Managed Care

Formulary Resources

Prior Authorization

Manufacturer Resources

Name Number
Drug Addition Process (PDF)  
Texas Drug Code Index Certification of Information HHS 1326
CHIP Drug Rebate Agreement (PDF) HHS 1337
CSHCN Drug Rebate Agreement (PDF) HHS 1343
KHC Program Drug Rebate Agreement HHS 1329
Value-Based Agreement Concept HHS 1402

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

    Delimited Data Files

    Data File Layout File
    Formulary Drug Index (zip) (Updated June 1) Layout (PDF)
    Formulary Product Index (zip) (Updated June 1) Layout (PDF)
    Formulary Clinical Prior Authorization Index (txt) (Updated June 1) Layout (PDF)
    Formulary HTW Program (XLS) (Updated Feb. 2020) Layout (PDF)
    Formulary NDC-to-HCPCS Crosswalk (Updated quarterly) Layout (PDF)
    Pharmacy Pharmacy Index (txt) (Updated June 1) Layout (PDF)
    Prescriber Prescriber Index (ZIP) (Updated June 1) Layout (PDF)