Continuing Pharmacy Education

Pharmacies contracted with the Vendor Drug Program are in a unique position to help Medicaid clients and provide access to the whole array of pharmacy benefits.  You can learn more about these and other pharmacy outreach initiatives and training opportunities at txvendordrug.com.

 

• 72-Hour Emergency Overrides for Prior Authorization-Required Drugs:

State and federal law requires a pharmacy to dispense a 72-hour emergency supply of a prescribed drug when a medication is needed without delay and prior authorization (PA) is not available.  This rule applies to non-preferred drugs on the Preferred Drug List (PDL) and any drug that is affected by clinical edits that would need the prescriber’s prior approval.  Full instructions are available online for downloading and displaying in your pharmacy.

• Free Continuing Education Credits are Just a Click Away

HHSC offers five free computer-based training courses to enhance your ability to provide pharmacy services to children with Medicaid.  The courses are accredited by the Accreditation Council of Pharmacy Education (ACPE).

• Separate Billing for Outpatient Prescriptions and DME
  • Pharmacies are encouraged to provide DME and medical supplies – such as spacers for inhalers, diabetic test strips, and lancets – to Medicaid clients.  To participate, pharmacy providers must complete an enrollment application with the Texas Medicaid & Healthcare Partnership (TMHP).  Applications are available at tmhp.com.  For assistance, please contact the TMHP Contact Center at 1-800-925-9126, or e-mail TMHP Provider Relations to request assistance from the local provider relations representative in your area.
  • For clients enrolled in Medicaid managed care health plans, pharmacies must enroll with their individual health plans for reimbursement.  TMHP offers a number of free training seminars each year.  Pharmacy staff can view a schedule and register for upcoming workshops at tmhp.com.  A free computer-based training module for pharmacy DME providers is available through the TMHP Learning Management System.
• Comprehensive Care Program Assists Medicaid Children
  • The Medicaid Comprehensive Care Program (CCP) can cover medically necessary drugs and supplies that are not available through Vendor Drug for clients up to 20 years of age.  Pharmacies not enrolled with CCP should direct the client to call the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-335-8957 to find a CCP pharmacy provider.  Pharmacies that want to enroll should complete an application at tmhp.com.  For help, contact the TMHP Contact Center at 1-800-925-9126, or e-mail TMHP Provider Relations to request assistance from the local provider relations representative in your area.
  • Pharmacies must enter into a contract with the client’s individual health plan to be reimbursed for DME and medical supplies or CCP services.
• Client Eligibility Verification Tools for Pharmacy Staff

Vendor Drug has developed two tools to help pharmacy providers verify client eligibility. Both are available after hours and on weekends.  One verification method is the National Council for Prescription Drug Programs (NCPDP) E1 transaction that may be submitted from the pharmacy’s point-of-sale system.  The other verification method is the free, online Eligibility Verification Portal (EVP).  Both methods provide out-patient pharmacy eligibility data and prescription benefits for individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), Children with Special Health Care Needs (CSHCN) Services Program, or Kidney Health Care (KHC) program.

• Temporary Medicaid Eligibility Verification Form (1027-A)

Medicaid clients may present the Temporary Medicaid Eligibility Verification form (Form 1027-A) as evidence of Medicaid eligibility. While this form might not have a Medicaid number, it is an official state eligibility document and can be relied upon as proof of Medicaid eligibility until the family receives the Medicaid Identification Form.

• Medicaid/CHIP IMPROVEs State, Provider Communication

IMPROVE (Interactive Medicaid Provider Voice) is a web-based, provider-focused initiative designed to foster better relations and understanding between medical providers and Medicaid. IMPROVE allows providers to suggest resolutions to systemic issues within the Medicaid program.