Last week TPA staff met with HHSC Vendor Drug Program (VDP) staff and other pharmacy stakeholders in the agency's quarterly stakeholder meeting. Andy Vasquez and VDP staff shared important changes ahead. Key discussion items included:

• Provider Re-enrollment
• DUR Board
• Fee-For-Service Reimbursement

Provider Re-enrollment

As many of you are aware, the Affordable Care Act requires HHSC to re-enroll all Medicaid providers. Pharmacies that wish to continue as Medicaid providers must submit their application by June 17^th in order to guarantee re-enrollment by the September 24, 2016 deadline. The VDP will continue to accept applications after June 17^th, but will not guarantee that the re-enrollment will be completed by the September deadline. Those not completed by the deadline will have their claims denied.

Currently VDP has received 3,734 of 4,938 pharmacy applications. This breaks down to 85 percent of chain pharmacies and 65 percent of independent pharmacies having submitted their applications. As the deadline approaches, VDP will continue to reach out to those pharmacies that have not submitted their applications.  Have you submitted your application? Check your status Here!

*Important note - Federal law requires HHSC to perform provider integrity checks on a monthly basis.

DUR Board

Members of the Drug Utilization Review (DUR) Board have now been announced! Included in those members is TPA member “Gene” Adams.The newly combined Pharmaceutical & Therapeutics Committee and DUR Board is hosting its first meeting today.

Fee-For-Service Reimbursement

Effective June 1, HHSC will change the reimbursement methodology for those under the Fee-For-Service program. Under the new reimbursement methodology, pharmacies will receive a professional dispensing fee of $7.93 + (1.96 per cent of ingredient cost) per claim.  It is important to note that the ingredient cost will reflect the type of pharmacy (Retail, Long term care (LTC), and Specialty) as follows:

• Retail – NADAC, or (WAC -2 per cent) if no NADAC present.
• LTC – (NADAC -2.4 per cent), or WAC -3.4 per cent) if no NADAC present.
• Specialty – (NADAC – 1.7 per cent) or (WAC – 8 per cent) if no NADAC present.