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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Appendix B: Vendor Drug Program : B.1 Vendor Drug Program : B.1.1 VDP Benefits for Medicaid Fee-for-Service (FFS) Clients

B.1.1
The Medicaid drug benefit for Medicaid FFS clients is limited to three prescriptions per month with the following exceptions that have unlimited prescriptions:
Note:
The following categories of drugs do not count against the three prescription per month limit:
FFS clients can be “locked-in” or “limited” to a specific pharmacy. FFS clients who are “locked-in” to a primary-care pharmacy have “LIMITED” printed on their Your Texas Benefits Medicaid card. 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 and are not subject to the three-prescription limit:
The VDP does not reimburse claims for nutritional products (enteral or parenteral), medical supplies, or equipment other than insulin syringes.

Texas Medicaid & Healthcare Partnership
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