Tag - Vendor Drug Program

Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and Human Services Commission Vendor Drug Program. The health plans opted to remove the requirements for diagnoses, while maintaining criteria for age and duplicate therapy [...]

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing [...]

Provider Alert! LARC Billing Update

Paragard and Nexplanon have been added to the Long-Acting Reversible Contraceptives (LARC) Buy Back Program. Paragard IUD (manufactured by Teva) and Nexplanon Implant (manufactured by Merck), have been added to the LARC Buy Back program, as the Mirena and Skyla currently are. Mirena and Skyla are currently available from Walgreens Specialty Pharmacy (NOTE: that has not changed from before). The Texas Medicaid/CHIP Vendor Drug Program has verified which pharmacies the Paragard IUD and Nexplanon Implants are available. In the case of Paragard: Biologics, Inc, [...]