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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 2 Healthy Texas Women (HTW) Program Overview : 2.3 * Services, Benefits, Limitations, and Prior Authorization : 2.3.6 Drugs and Supplies

2.3.6
2.3.6.1
Providers may do one or both of the following:
Family planning drugs and supplies that are dispensed directly to the client must be billed to HTW. Only providers with an appropriate pharmacy license may be reimbursed for dispensing family planning drugs and supplies. Provider types with an appropriate pharmacy license may be reimbursed for dispensing up to a one-year supply of contraceptives in a 12-month period using procedure code J7303, J7304, or S4993.
Pharmacies under the Vendor Drug Program are allowed to fill all prescriptions as prescribed. Family planning drugs and supplies are exempt from the three prescriptions-per-month rule for up to a six- month supply.
Refer to:
“Appendix B: Vendor Drug Program” (Vol. 1, General Information) for information about outpatient prescription drugs and the Vendor Drug Program.
2.3.6.1.1
Certain LARC products are available as a pharmacy benefit of HTW and are available through a limited number of specialty pharmacies that work with LARC manufacturers. Providers can refer to the Texas Medicaid/CHIP Vendor Drug Program website at www.txvendordrug.com/formulary/larc.shtml for additional information, including a list of covered products and participating specialty pharmacies.

Texas Medicaid & Healthcare Partnership
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