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Medicaid Vendor Drug Program Pilot Study Recommendations

Texas Health and Human Services Commission

A. The Texas Health and Human Services Commission should consider enhancing the Medicaid Vendor Drug Program claim processing system in the following ways:

• provide complete Medicaid recipient (name, address and eligibility) information to correspond with the recipient’s Medicaid program identification number;

• add the prescribing provider’s new Medicaid provider identification number to facilitate cross referencing between the Medicaid and Vendor Drug Program claim processing systems; and

• add edits to suspend payments when the prescription is suspect such as age inappropriate to drug.

B. The Office of Investigation and Enforcement should conduct regular audits on the Vendor Drug Program to identify potential fraudulent or abusive practices by either the pharmacies or prescribing providers.

C. The Vendor Drug Program department should perform educational seminars in partnership with the Texas State Board of Pharmacy, at least annually, for all pharmacists and prescribing providers instead of targeted onsite education during routine audits. These seminars should include information on common prescription errors, federal and state requirements and any new federal or state information appropriate to the Medicaid Vendor Drug Program.

Fiscal Impact
These recommendations can be implemented within this agency’s current
appropriations.