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December 2016 Texas Medicaid Provider Procedures Manual

Appendix B: Vendor Drug Program : B.1 Vendor Drug Program : B.1.2 Pharmacy Delivery Method for Clinician-Administered Drugs

B.1.2
Providers administering clinician-administered drugs in an outpatient setting for Medicaid fee-for-service (FFS) and Medicaid Managed Care Organization (MCO) clients can send a prescription to a pharmacy and wait for the drug to be shipped or mailed to their office. This delivery method is called “white-bagging.”
Providers should use the following steps for this delivery method:
1)
2)
3)
If any prior authorization is approved, the dispensing pharmacy fills the prescription and overnight ships an individual dose of the medication, in the name of the Medicaid client, directly to the treating provider.
4)
The treating provider administers the medication to the Medicaid client in the office setting. The provider bills for an administration fee and any medically necessary service provided at time of administration. The provider should not bill Medicaid for the drug.
The pharmacy contacts the provider each month, prior to dispensing any refills, to ensure that the patient was administered all previously dispensed medication. Auto-refills are not allowed.
These medications cannot be used on any other patient and cannot be returned to the pharmacy for credit.
Exception:
Note:
Physicians who use this delivery method will not have to buy the clinician-administered drug, therefore, the physician is allowed to administer the drug and should only bill for the administration of the drug.

Texas Medicaid & Healthcare Partnership
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