The Texas Vendor Drug Program (VDP) Form 1332, also known as the Pharmacy Ownership Transfer Affidavit, is a mandatory document used when a pharmacy enrolled in Texas Medicaid undergoes a change of ownership. Since Medicaid participation involves strict financial accountability, the state requires both parties—the outgoing owner (Seller) and the incoming owner (Buyer)—to formally acknowledge their responsibilities under oath.
The TX HHS Form 1337, CHIP Drug Rebate Agreement, is a crucial document that helps solve the problem of establishing rebates for prescription outpatient drugs utilized by Children's Health Insurance Program (CHIP) recipients. This form is typically used in situations where manufacturers or labelers need to agree on rebate rates with the Texas Health and Human Services Commission (HHSC). The form is usually filled out by representatives from the manufacturer/labeler side.
The TX HHS Form 1338, Cystic Fibrosis Treatment Agents Prior Authorization Request, is a crucial document for healthcare providers to request prior authorization for patients with cystic fibrosis who require treatment agents such as Kalydeco, Orkambi, or Symdeko. This form helps solve the problem of ensuring that patients receive necessary medication while also streamlining the approval process.
The TX HHS Form 1342, Draft Policy Comment Submission, is a crucial tool for stakeholders to provide feedback on proposed policies within the Vendor Drug Program (VDP). This form helps ensure that all comments are considered when finalizing the policy, allowing for a more comprehensive and effective implementation.
The Texas Vendor Drug Program MCO Search Update Request Form 1344 helps managed care organizations (MCOs) update their information in the Texas Vendor Drug Program database. This form is typically used by MCOs to modify or delete existing information related to their organization.
The TX HHS Form 1347, Emflaza Prior Authorization Request, is a crucial document that helps healthcare providers obtain prior authorization for the treatment of Duchenne muscular dystrophy patients with Emflaza (deflazacort). This form is used in situations where patients require ongoing treatment and need to demonstrate that they meet specific criteria for continued therapy.
The Texas Medicaid Phosphate Binders Prior Authorization Request Form (Form 1348) is a crucial tool for healthcare providers to obtain prior authorization for phosphate binders treatment. This form helps solve the problem of ensuring that patients receive necessary medication while also streamlining the review process.
The TX HHS Form 1349, Drug Utilization Review Board Annual Disclosure, is a crucial document that helps solve the problem of ensuring accurate and timely disclosures from individuals appointed to the Texas Vendor Drug Program's Drug Utilization Review Board. This form is typically used in situations where an individual is initially applying to the board or has been appointed and needs to submit their annual attestation.
The TX HHS Form 1351, Request to Withdraw from the CLASS Application Process, is a practical tool for individuals who have received information about the Community Living Assistance and Support Services (CLASS) Program. This program provides individualized services to persons with related conditions living in the community.
The Texas Medicaid OxyContin Prior Authorization Request Form 1353 helps healthcare providers obtain approval for patients' prescriptions of OxyContin. This form is specifically designed for patients enrolled in Medicaid fee-for-service and is used to request prior authorization for the medication.
