TMPPM 2010 > Volume 1, General Information > Appendix B: Vendor Drug Program > Vendor Drug Program

B.1 Vendor Drug Program

The Texas Medicaid Vendor Drug Program (VDP) makes payment for prescriptions of covered outpatient drugs only to those pharmacy providers contracted with the VDP. In-state pharmacies licensed as Class A or C by the Texas State Board of Pharmacy are eligible for enrollment in the VDP. Out-of-state pharmacies and pharmacies holding any other class of pharmacy license are considered for inclusion in the program on a case-by-case basis, relative to the benefits made available to a client eligible for Texas Medicaid. Contracts are not granted to applicants unless additional benefits to the recipient are established.

The only drugs eligible for VDP reimbursement are listed in the current Texas Listing of National Drug Codes. Additionally, a searchable Texas Drug Code Index (TDCI) can be found on the HHSC VDP website at www.txvendordrug.com/dw/FormularySearch.asp. Drug information (including prior authorization requirements) can be found in this searchable listing. If the drug does require prior authorization, the prescribing physician or representative must call the Texas Prior Authorization Center Hotline (1-877-PA-TEXAS). The VDP does not reimburse claims for nutritional products (enteral or parenteral), medical supplies, or equipment.

For more information on the VDP, contact:

The Texas Medicaid Preferred Drug List is also available on the Epocrates drug information system. The service is free and provides instant access to information on the drugs covered by the Texas formulary on a Palm or Pocket PC handheld device. To register for the service, go to the Epocrates website at www.epocrates.com/products/ and sign up for Epocrates Rx.

Texas Medicaid drug formulary and preferred drug list information is also available online at www.smartformulary.com/tx. Smartformulary includes links attached to selected non-preferred drugs that will guide you to the preferred drug in that therapeutic class.

Clients who are not locked-in to a specific pharmacy may obtain their drugs or supplies from any contracted Medicaid provider of pharmaceutical services.

Refer to: Subsection 4.4.2, "Client Limited Program" in Section 4, Client Eligibility (Vol. 1, General Information) for more information about lock-in limitations.

Family planning services are excluded from lock-in limitation. Though TMHP reimburses family planning agencies and physicians for family planning drugs and supplies, the following family planning drugs and supplies are also available through the VDP:

•Diaphragms

•Oral contraceptives

•Jellies, creams, foams, suppositories, vaginal contraceptive film, and contraceptive sponge

•Medication for treatment of vaginal/cervical/genital infections (subject to the three prescription limit)

The VDP is limited to three prescriptions per month, per client, except for:

•Clients enrolled in waiver programs such as managed care, Class, Community-Based Alternatives (CBA).

•Texas Health Steps (THSteps)-eligible clients (clients who are 20 years of age or younger) unlimited, but must be medically necessary and appropriate.

•Residents in skilled nursing facilities, unlimited.

•Clients enrolled in the State of Texas Access Reform (STAR) Program, and residing in a STAR Program service area, unlimited.

Refer to: Subsection 8.2.4, "Service Areas and STAR HMO Choices" in Section 8, "Managed Care" (Vol. 1, General Information).

•Prescriptions for family planning drugs and supplies are not subject to the three prescription limit.