Resources for Prescribers
Medicaid Fee-For-Service (FFS) Info for Prescribers
The Texas Medicaid Vendor Drug Program is charged with insuring that Medicaid fee-for-service (FFS) recipients have access to out-patient prescription medications. For more information on this program, please visit: http://www.txvendordrug.com/.
Prescribers now have two options on how to request prior authorizations for FFS recipients:
- A call to the Texas Prior Authorization Call Center at 1-877-PA-TEXAS (1-877-728-3927) for preferred drug and/or clinical prior authorization.
- An online submission to PAXpress - Registration Instructions
Note: at this time, this feature is only available for non-preferred drug prior authorization requests.
PAXpress link: https://paxpress.txpa.hidinc.com/
Medicaid Managed Care Organization (MCO) Info for Prescribers
Medicaid managed care organizations contract with Pharmacy Benefit Managers (PBM) to administer pharmacy benefits for Medicaid managed care recipients. For more information, please visit: http://www.txvendordrug.com/managed-care/
- Prior Authorization is required for non-preferred drugs and drugs subject to clinical PA edits. MCOs/PBMs may implement any of the Vendor Drug Program’s clinical PAs, but not more stringent.
- Prior Authorization Call Center phone numbers may vary by Medicaid managed care health plan.
- MCOs must notify the prescriber’s office of a PA approval/denial within 24 hours of the time of the phone request.
NEW August 2015: the three formulary searches on the Texas Vendor Drug Program website - Main, LHHS/V&M, TWHP - will be combined into two searches (one for drugs, one for products) and will appear on one page at http://www.txvendordrug.com/formulary/.
Texas Medicaid Vendor Drug Program has a searchable formulary available online with links attached to selected non-preferred drugs that will guide you to the preferred drugs in that therapeutic class. Please visit http://www.txvendordrug.com/formulary/enhanced-form-search.shtml.
The Texas Medicaid formulary and http://www.txvendordrug.com/formulary/preferred-drugs.shtml are available on the Epocrates drug information system. The service is free and provides instant access to information through internet or on handheld device about the products on the Texas Medicaid formulary. Visit http://www.txvendordrug.com/formulary/epocrates.shtml for more information.