Texas Medicaid/CHIP Drug Vendor Program News
Pharmacy Delivery Method for Clinician-Administered Drugs
October 8, 2015
Providers dispensing clinician-administered drugs in an outpatient setting for fee-for-service (FFS) Medicaid and Medicaid managed care clients can utilize an optional delivery method referred to as white bagging, in which the provider submits prescriptions to pharmacies and the prescription is shipped or mailed to the provider’s office. This delivery method is voluntary for Medicaid participating providers. Medicaid MCOs cannot require the use of white-bagging for clinician-administered drugs.
Providers must adhere to the following when using this delivery method:
- The treating provider identifies a Medicaid-enrolled client.
- The treating provider or treating provider’s agent sends a single prescription, with no additional refills, to a Texas Medicaid-enrolled pharmacy and obtains any necessary prior authorizations. The provider must write a new prescription for any additional fills.
- Once approved, the dispensing pharmacy fills the prescription and ships or mails an individual dose of the medication overnight. The prescription will arrive at the treating provider's office in the name of the Medicaid client. These medications must not be used for any other patient and cannot be returned to the pharmacy for credit.
- The treating provider administers the medication to the Medicaid client in the office setting. The treating provider must not bill Medicaid for the drug. The treating provider is only allowed to bill for an administration fee and any other medically necessary service provided at time of administration. [Other service could be performed at the same visit in addition to any E/M, such as: other medications or immunizations maintained in the office and administered treatments, procedures, x-rays, or labs.]
June 5, 2015
Beginning June 15, Makena® (hydroxyprogesterone caproate injection) will be available as a pharmacy benefit through the Texas Medicaid Vendor Drug Program.
National Drug Code (NDC)
Makena 1250 mg / 5 ml vial
As a pharmacy benefit, Makena will require a clinical prior authorization for fee-for-service. Medicaid health plans may elect to require the same clinical prior authorization for Makena. Please refer to the appropriate health plan for specific requirements. Pharmacy staff should continue to direct providers to the Texas Prior Authorization Call Center at 1-877-PA-TEXAS (1-877-728-3927) to obtain the prior authorization or complete the prior authorization form for fee-for-service clients.
Makena and the compounded version of 17P will continue to be available as a Medicaid medical benefit. For additional information about the medical benefit, please visit the TMHP website or call the TMHP Contact Center at 1-800-925-9126.
Hydrocodone Reclassified As Schedule II
October 1, 2014
Beginning October 6, 2014, all hydrocodone combination products will be reclassified as Schedule II drugs. Written prescriptions for hydrocodone combination products must be prescribed on an official prescription pad as required by the Texas Department of Public Safety. As a result of this change, Advanced Practice Registered Nurses and Physician Assistants will no longer be able to prescribe hydrocodone except in the hospital setting as allowed by law.
The Vendor Drug Program will not allow refills on any prescription written prior to October 6 for clients enrolled in Medicaid, the Children with Special Health Care Needs (CSHCN) Services program, the Kidney Health Care (KHC) program, or the Texas Women’s Health Program (TWHP). This direction also applies to the clients enrolled in Medicaid Managed Care or the Children’s Health Insurance Program (CHIP).
As a reminder, prescribing physicians are allowed under law to electronically prescribe Schedule II prescriptions. Prescribers should contact their software provider to learn more about electronic submission.