HHSC Texas Medicaid Physician Administered Drugs/Biologicals

Pursuant to the 81st regular Legislative session, this is the expedited process for:

• Requesting coverage of physician-administered drugs, biologicals or vaccines (hereafter referred to as drugs).
• Adding new indications for current drugs.

This site is only for physician-administered drugs.

This site is NOT for oral, inhaled, topical, or patient-administered drugs. Questions about those should be sent to the Vendor Drug Program (click here).

Download the Texas Medicaid Physician Administered Drug Referral Form if you want to:

• Request coverage for a drug with a current HCPCS code
• Request coverage for new indications for a drug with a current HCPCS code
• Request coverage for a new drug with a pending HCPCS code

[Do not contact HHSC Medicaid/CHIP program about new FDA approved drugs until there has been a Centers for Medicare & Medicaid Services (CMS) hearing that resulted in approval for a unique code. Requests lacking the hearing date will not be accepted.]

HHSC does not make coverage decisions for drugs billed using miscellaneous codes. For information on how to bill for drugs which do not have a unique HCPCS code, click here.

Questions about reimbursement rates should be directed to the Rate Analysis Department through Dan.Huggins@hhsc.state.tx.us

For comments, recommendations, or questions, please e-mail your correspondence to: MedicaidBenefitRequest@hhsc.state.tx.us Attn: Patricia Aranda