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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.1 Managed Care Services : 2.1.2 Prescription Drug/Pharmacy Services

2.1.2
Pharmacy services rendered to Medicaid managed care clients are administered and paid by the clients’ MCOs according to S.B. 7, 82nd Legislature, First Called Session, 2011.
Pharmacy providers must first be contracted with the Medicaid/Children’s Health Insurance Program (CHIP) Vendor Drug Program before they can contract with the MCOs.
Refer to:
Generally, there is no monthly prescription limit for managed care clients.
Refer to:
Each MCO contracts with one Pharmacy Benefit Manager (PBM). The MCOs and PBMs must adhere to Medicaid preferred drug list (PDL) and HHSC Medicaid and CHIP formularies.
HHSC will manage the Texas Medicaid and CHIP formularies.
The MCOs will:
Important:

Texas Medicaid & Healthcare Partnership
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