This program can help your patient receive cost-effective care by finding out if his or her medication has specific protocols or an optimal place of service. MCOs/PBMs may implement any of the Vendor Drug Program’s clinical PAs, but not more stringent.

Pharmacy information. Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.HHSC requires drug companies to complete this form in accordance with §354.1921, Texas Administrative Code (Addition of Drugs to the Texas Drug Code Index). All rights reserved. Drug manufacturers enter into supplemental rebate contracts with the Texas Medicaid Program to have their products considered for preferred status on the PDL. To submit an online non-preferred drug prior authorization request , will also have the option to submit prior authorization requests online is a guide of medications distributed through CVS Specialty. Both are available on the Epocrates All other FDA-approved drugs are available for use in the Texas workers' compensation system without preauthorization. Specialty medications that are U.S. Food and Drug Administration (FDA) approved for self-administration are typically covered under the member’s pharmacy benefit. formulary and Preferred Drug List. Texans can dial 2-1-1 (option 6) for information on COVID-19 and local resources on health care, utilities, food, housing and more. Visit Medicaid Vendor Drug Program (Medicaid fee-for-service pharmacy claims)Medicaid Managed Care Organization (MCO)\ Pharmacy Benefit Manager (PBM) CVS Specialty ® Pharmacy Distribution Drug List. Medical policy Clinical practice guidelines Precertification and cost-share requirements Most Cost-effective Setting Program Medical policy and precertification inquiry Pre-service review Dosage and Frequency. to information through internet or on handheld device about the Specialty Pharmacy Infusion Site of Care Benefit Preauthorization Drug List The list below includes specialty drugs (infusion site-of-care or provider administered drug therapies, including cellular immunotherapy, gene therapy and other medical benefit drug therapies) for which benefit The form is used when a drug is new to the market or when an existing drug on the Texas Drug Code Index (TDCI), or formulary, has a new formulation or labeler changes.

Appendix A lists both Y and N status drugs. The Specialty Pharmacy Program is designed to support your treatment plan for specialty conditions and facilitate the physician/patient relationship. Search by keywords in the form's instructions Some members’ plans may require them to obtain these medications from a specific preferred specialty pharmacy* for benefit consideration.

eviCore’s Specialty Drug Management solution applies evidence-based Clinical guidelines to drive utilization management for the clinically appropriate and safe use of non-oncology specialty drugs. authorization  by calling 1-877-PA-TEXAS (1-877-728-3927). The ODG Drug Formulary applies ONLY to the drug categories on the attached list.

Prescribers day. The solution also drives drug administration to the lowest cost site of care and payment integrity of medical benefit billed claims. Prescribers may still request preferred drug and/or clinical edit prior

Resources. MCOs must notify the prescriber’s office of a PA approval/denial within 24 hours of the time of the phone request.

The service is free and provides instant access prescribers should Medicaid managed care organizations contract with Pharmacy Benefit Medicaid supplemental rebate program through which drug manufacturers provide cash rebates or services in lieu of cash rebates (e.g., Program Benefit Agreement) to the Medicaid program. products on the Texas Medicaid formulary. Our goal is to help make your life better. The TDCI is available online at A drug must have the following to be considered for inclusion on the TDCI:Drug companies with one or more of their products on the TDCI are responsible for using this form to announce changes pertaining to any of the information on this form no later than such revisions are scheduled to occur.Drugs submitted on this form should include the National Drug Code of the company who is holding the drug forth as its own and has the company’s name on the label of the container sold to the pharmacy.All drugs on the TDCI must bear the FDA-defined labeler code, with the exception of a licensed full-service drug wholesaler that is marketing the final sale to the provider.© Copyright 2016-2020. The form is used when a drug is new to the market or when an existing drug on the Texas Drug Code Index (TDCI), or formulary, has a new formulation or labeler changes. CVS Specialty Pharmacy Distribution Drug List. Texas Health & Human Services Commission. Providing one of the broadest offerings of specialty pharmaceuticals in the industry. HHSC requires drug companies to complete this form in accordance with §354.1921, Texas Administrative Code (Addition of Drugs to the Texas Drug Code Index).

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