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Changes to Pharmacy Enrollment and Revalidation Begin April 1, 2021

Last updated on 3/5/2021

Note: The Health and Human Services Commission (HHSC) has requested that TMHP publish the following information:

Beginning April 1, 2021, Texas Medicaid & Healthcare Partnership will take over all Vendor Drug Program (VDP) pharmacy enrollment operations following the launch of the Provider Enrollment and Management System (PEMS).

The system will automate and streamline the provider enrollment process. PEMS will be a single tool for enrollment, re-enrollment, revalidation, and file maintenance requests. On April 1, 2021, all pharmacy providers will use PEMS to enroll, re-enroll, revalidate, and submit changes to maintain their enrollment information for the Texas Vendor Drug Program.

Though Federal law requires all providers to revalidate their Medicaid enrollment at least every five years, the Centers for Medicare & Medicaid Services (CMS) provided extensions to the revalidation date due to the public health emergency (PHE). Refer to the CMS guidance titled, “Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency.”

Pharmacy revalidation dates falling under the PHE were extended. Beginning April 1, 2021, TMHP will contact pharmacies 120 days before their enrollment end date to inform pharmacies when to begin the revalidation process.

HHSC VDP will no longer accept paper revalidation applications as of March 8, 2021. Pharmacies must complete revalidation applications in PEMS beginning April 1, 2021.

VDP will continue to accept and process new applications until TMHP takes over pharmacy enrollment operations through PEMS beginning April 1, 2021.

What to do now

Pharmacy staff must create an online account as soon as possible to prepare for the automated system. The account will allow pharmacies to access and utilize PEMS. HHSC will continue to administer claims and payment functions.

For further support with PEMS, contact the TMHP Contact Center at 800-925-9126, or refer to the previous web article on the TMHP website for information on how to create a portal account.

In the coming weeks

Beginning in March 2021, TMHP will provide training on PEMS. VDP and TMHP will announce training opportunities once finalized.

TMHP and HHSC will communicate by fax, email, web articles, and updates to the VDP and TMHP websites regarding revalidation due dates based on state and federal flexibilities.

Failure to complete the revalidation process by the enrollment end date may result in disenrollment and a loss of eligibility to receive Medicaid reimbursement. All revalidations, including revalidation during the PHE and other enrollment actions will occur in PEMS beginning April 1, 2021.

For pharmacy enrollment support not related to PEMS, email vdp-enrollment@hhsc.state.tx.us or call the HHSC Pharmacy Benefits Access Help Desk at 1-800-435-4165.