Vendor Drug Program – The Checkup

09MayMay 9, 2023

Provider Alert! Subject: Unclassified Medical Drugs Prior Authorization Requirement

Date: May 8, 2023 Attention: All Providers Effective Date: June 8, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 8 2023, medical claims under $5,000 submitted to TCHP with unclassified Healthcare Common Procedure Coding System (HCPCS) code J3490 will no longer require a pre-service (prior authorization) request as claims above this cost will be subject to clinical necessity review by the pharmacy team. This dollar limit does not apply to other unclassified codes J9999, J3590,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHCPCS, Prior Authorization, Unclassified Medical Drugs, VDP, Vendor Drug Program0 CommentsRead more...

13OctOctober 13, 2022

Provider Alert! September 2022 Specialty Drug List Available

Date: October 11, 2022 Attention: All Providers Effective Date: September 28, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: The September 2022 Biannual Specialty Drug List (SDL) is now available from the vendor drug program website. How this impacts providers: Providers should refer to the vendor...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsSDL, specialty drug, VDP, Vendor Drug Program0 CommentsRead more...

15SepSeptember 15, 2022

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: September 14, 2022 Attention: All Providers Effective Date: July 28, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsformulary changes, PDL, Preferred Drug List, VDP, Vendor Drug Program0 CommentsRead more...

12AprApril 12, 2022

Provider Alert! March 2022 Specialty Drug List Available

Date: April 7, 2022 Attention: Providers Effective Date: March 31, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: The March 2022 Biannual Specialty Drug List is now available from the Vendor Drug Program Website. How this impacts providers: A drug must meet all four of the...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsspecialty drug, Vendor Drug Program0 CommentsRead more...

24SepSeptember 24, 2021

Provider Alert! 2021-2022 Respiratory Syncytial Virus Season and Synagis (palivizumab)

Date: July 23, 2021 Attention: All Providers Treatment start date: October 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. **This notice may be updated as new regions are opened or closed Call to action: The traditional 2021-22 Respiratory Syncytial Virus (RSV) season is here! The Texas RSV Region...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsprovider alert, RSV, Synagis, VDP, Vendor Drug Program0 CommentsRead more...

07MayMay 7, 2020

Provider Alert! COVID-19 Medicaid Pharmacy Benefit Updated May 4, 2020

Attention: All Providers and Pharmacies Effective Date: May 4, 2020 The Texas Vendor Drug Program (VDP) has implemented several changes in response to COVID-19. This notice contains the latest updates, as well as links to the previously implemented changes. No-auto prior authorization (NAP) designation temporarily lifted: Normally, medications listed as NAP on the drug formulary by VDP require a manual hard stop in the system. Providers must call/fax to complete a prior authorization (PA) rather than allowing automated authorizations by reviewing historical pharmacy...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, medicaid, Pharmacy, provider alert, provider alerts, VDP, Vendor Drug Program0 CommentsRead more...

20AugAugust 20, 2018

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 in...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, SpecialistsAntipsychotic Clinical Prior Authorization Edit, Navitus, Prior Authorization, Vendor Drug Program0 CommentsRead more...

12MarMarch 12, 2017

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 to...

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, Specialistsappeal, Navitus, Prior Authorization, Utilization Management, Vendor Drug Program0 CommentsRead more...

09JunJune 9, 2016

Do you know how to access the Texas Children’s Health Plan formulary?

Texas Children’s Health Plan follows the State of Texas Medicaid and CHIP formulary that is managed by the Texas Medicaid/CHIP Vendor Drug Program. Prescribers and their staff can easily access the formulary online at: http://www.txvendordrug.com/formulary/index.asp. By visiting this website, you can search for either a drug or product by either NDC, brand name, generic name, or class. The results will show: Drug Program Type (Drugs covered by Medicaid(STAR) will display a V, Drugs covered by CHIP will display a P) Drug Name Generic Name NDC number that...

By Texas Children's Health PlanFacilitiesChip Formulary, Drugs, ePocrates, Formulary, VDP, Vendor Drug Program0 CommentsRead more...

17MarMarch 17, 2016

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, Specialty...

By Texas Children's Health PlanOB/GYNs, Office ManagersCHIP, IUD, LARC, medicaid, Nexplanon, Paragard, reversible contraception, Vendor Drug Program0 CommentsRead more...

Tag - Vendor Drug Program