Texas Medicaid Drug Vendor File (340B and AAC Pricing)

Status

To Do

Data Source

Update Frequency

WeeklyQuarterly

Texas Medicaid Drug Vendor File (340B and AAC Pricing)

Description

Used to make comparisons in drug pricing to pharmacy acquisition costs. Supplements NADAC where NADAC prices don’t exist. Also has 340b pricing.

Homepage | Vendor Drug Program

A drug must meet all four of the rule criteria to be considered for inclusion on the HHSC specialty drug list (SDL). The SDL includes drugs MCOs may exclusively provide through their specialty pharmacy network.

www.txvendordrug.com

23,340 distinct NDCs as of 10/3/22

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Source Links

Download

Data Files | Vendor Drug Program

Formulary Drug File Layout

This layout document describes the fields in the formulary drug search data file.

www.txvendordrug.com

Actual link to file download (TXT)

www.txvendordrug.com

Example file downloaded, pipe delimited, and converted to Excel 10/3/22

formulary-drug-index.xlsx4799.1KB

API

Update Frequency

Weekly - maybe on Mondays?

Depends… Example below from download website

Legend

1 - Weekly published file, last updated Dec. 16, 2024
2 - Quarterly published file, last updated Oct. 15, 2024
3 - File last updated Feb. 2024

Licensing

Table Info

Formulary Drug File Layout

This layout document describes the fields in the formulary drug search data file.

www.txvendordrug.com

Field Name	Description	Length	Format	Note
Drug_Generic	Identifies the generic name of drug	35
Drug_HTW_code	Identifies whether the drug is active on Healthy Texas Women (HTW) Program formulary	3
Drug_limit_fp	Identifies whether the drug is a family planning drug	3
Drug_limit_ds	Identifies whether the drug is a diabetic supply drug	3
Drug_limit_ppg	Identifies whether the drug has premium preferred generic (PPG) pricing	3
Drug_limit_ppg	Identifies the refill utilization percentage	3		Refer to the Refill Utilization section of the pharmacy manual for more information
Drug_NDC	Identifies the 11-digit National Drug Code (NDC) number	11
Drug_Descr	Identifies the First Databank (FDB) label name of the drug	35
Drug_Pkg	Identifies the package size of the drug	12	ZZZZZZ.99999
Drug_Unit	Identifies the unit of measure of the drug	2		• GM = Gram • ML - Milliliter • EA = Each
Drug_340B	Identifies the Texas reimbursement rate for 340B drugs	14	ZZZZZZ.99999
Drug_med_EffDate	Identifies the effective date of the drug on Medicaid formulary	10	MM/DD/CCYY
Drug_med_EndDate	Identifies the termination date of the drug on the Medicaid formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_Med_Code	Identifies whether the drug is active on the Medicaid formulary	3
Drug_CMP_V	Identifies whether the drug is only available for multi-ingredient compound Medicaid claims	3
Drug_Med_Comment	Identifies any paper prior authorization form requirements for drugs on the Medicaid formulary	60
Drug_chip_EffDate	Identifies the effective date of the drug on CHIP formulary	10	MM/DD/CCYY
Drug_chip_EndDate	Identifies the termination date of the drug on the CHIP formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_chip_code	Identifies whether the drug is active on the CHIP formulary	3
Drug_CMP_P	Identifies whether the drug is only available for multi-ingredient compound CHIP claims	3
Drug_cshcn_EffDate	Identifies the effective date of the drug on the CSHCN formulary	10	MM/DD/CCYY
Drug_cshcn_EndDate	Identifies the termination date of the drug on the CSHCN formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_cshcn_code	Identifies whether the drug is active on the CSHCN formulary	3
Drug_CMP_C	Identifies whether the drug is only available for multi-ingredient compound CSHCN claims	3
Drug_cshcn_comment	Identifies any paper prior authorization form requirements for drugs on the CSHCN formulary	60
Drug_khc_EffDate	Identifies the effective date of the drug on the KHC formulary	10	MM/DD/CCYY
Drug_KHC_EndDate	Identifies the termination date of the drug on the KHC formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_khc_code	Identifies whether the drug is active on the KHC formulary	3
Drug_CMP_K	Identifies whether the drug is only available for multi-ingredient compound KHC claims	3
Drug_htw_EffDate	Identifies the effective date of the drug on the HTW formulary	10	MM/DD/CCYY
Drug_htw_EndDate	Identifies the termination date of the drug on the HTW formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_legend_status	Identifies whether the drug is legend or over-the-counter	21		• Over the counter • Prescription required
Drug_PDL_pa_required	Identifies whether the drug requires a Medicaid non-preferred (PDL) prior authorization	3
Drug_pdl_EffDate	Identifies the effective date of the Medicaid non-preferred (PDL) prior authorization	10	MM/DD/CCYY
Drug_MKID	Identifies the drug's preferred prior authorization therapeutic class code	4		Refer to the valid values for the PDL therapeutic class description
Drug_Clinical_pa_required	Identifies whether the drug requires a Medicaid clinical prior authorization	3
Drug_Retail	Identifies the current acquisition cost for VDP-identified retail pharmacies	14	ZZZZZZ.99999
Drug_Retail_EffDate	Identifies the effective date of the current acquisition cost for VDP-identified retail pharmacies	10	MM/DD/CCYY
Drug_LTC	Identifies the current acquisition cost for VDP-identified long-term care pharmacies	14	ZZZZZZ.99999
Drug_LTC_EffDate	Identifies the effective date of the current acquisition cost for VDP-identified long-term care pharmacies	10	MM/DD/CCYY
Drug_SPC	Identifies the current acquisition cost for VDP-identified specialty pharmacies	14	ZZZZZZ.99999
Drug_SPC_EffDate	Identifies the effective date of the current acquisition cost for VDP-identified specialty pharmacies	10	MM/DD/CCYY
Drug_VAC	Identifies the current VDP acquisition cost when the drug does not have retail, LTC, or specialty pricing	14	ZZZZZZ.99999
Drug_VAC_EffDate	Identifies the effective date of the current VDP acquisition cost	10	MM/DD/CCYY
Drug_MKID_Desc	Identifies the drug's preferred prior authorization therapeutic class description	50		Refer to the valid values for the PDL therapeutic class description
ID	Identifies the 11-digit National Drug Code (NDC) number	11
Drug_med_EndReason	Identifies the reason for the drug's termination from the Medicaid formulary	50
Drug_chip_EndReason	Identifies the reason for the drug's termination from the CHIP formulary	50
Drug_cshcn_EndReason	Identifies the reason for the drug's termination from the CSHCN formulary	50
Drug_khc_EndReason	Identifies the reason for the drug's termination from the KHC formulary	50
Drug_limit_larc	Identifies whether the drug is a long-acting reversible contraception drug	3
Drug_limit_injection	Identifies whether the drug is long-acting injectable or Vivitrol	3
Drug_admin_fee	Identifies the administration cost value	14	ZZZZZZ.99999
Drug_manufacturer	Identifies the name of the drug manufacturer	15
Drug_HTWPLUS_code	Identifies whether the drug is active on HTW Plus Program formulary	3
Drug_htwplus_EffDate	Identifies the effective date of the drug on the HTW Plus formulary	10	MM/DD/CCYY
Drug_htwplus_EndDate	Identifies the termination date of the drug on the HTW Plus formulary	10	MM/DD/CCYY	A drug with a termination date will appear on the file for 90 days following the termination date
Drug_chip_comment	Identifies any paper prior authorization form requirements for drugs on the CHIP formulary	60
Drug_khc_comment	Identifies any paper prior authorization form requirements for drugs on the KHC formulary	60
Drug_medicare-B	Identifies an NDC considered a Medicare Part B covered benefit for dual eligible clients.	3
Drug_medicare-D	Identifies an NDC considered a wrap-around drug for Medicare Part D dual-eligible clients.	3
Drug_sdl_code	Identifies an NDC included on the Specialty Drug List.	3
Drug_sdl_EffDate	Identifies the effective date of an NDC included on the Specialty Drug List.	10	MM/DD/CCYY
Drug_sdl_EndDate	Identifies the termination date of an NDC included on the Specialty Drug List.	10	MM/DD/CCYY