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Name Change, Merge, and Reorganization of the Clinician-Administered Drugs Handbook and Appendix B: Vendor Drug Program in the TMPPM

Last updated on 8/21/2020

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Beginning September 1, 2020, the Texas Medicaid Provider Procedures Manual (TMPPM) Clinician-Administered Drugs Handbook will be renamed Outpatient Drug Services Handbook. Additionally, the contents of Appendix B: Vendor Drug Program, currently located in Volume 1 of the TMPPM, will be merged into the renamed handbook.

The following changes will also be incorporated in the Outpatient Drug Services Handbook:

  • Some tables will be reformatted and some sections will be reorganized.
  • The CAD injections table will be removed, and a section will be created for each injection that is not currently in an existing section.
  • Standard prior authorization language will be removed from some sections and a general prior authorization section will be created.

The following new information will be added to the Outpatient Drug Services Handbook:

  • Pharmacy manufacturer information and instructions
  • Retrospective Drug Utilization Reviews

For more information, call the TMHP Contact Center at 800-925-9126.