RECEIVING REBATES ON PRESCRIPTION DRUGS THROUGH MEDICAID IN TEXAS

Texas Medicaid is a federal and state funded health insurance program that provides health services to low-income households. Medicaid health insurance covers a wide range of services, including doctor visits, emergency care, necessary vaccines, dental care, and vision care. Medications prescribed by a doctor are also covered under Medicaid insurance. Antibiotics and other medications are sometimes necessary when fighting an infection, and prescriptions for mental illness are vital to a patient’s health. TX Medicaid offers a drug rebate program that allows necessary prescriptions to be covered under the state’s program.

The Medicaid Drug Rebate program covers all prescriptions drugs in Texas for individuals covered by Medicaid insurance. It is a program that involves the Center for Medicare and Medicaid Services (CMS), Texas Medicaid, and the participating drug manufacturers. Approximately 600 drug manufacturers participate in the Medicaid Drug Rebate program. The program requires drug manufacturers to sign a contract with the Center for Medicare and Medicaid services, stating that these manufacturers must pay rebates to the state of Texas based on the amount of medication units that were paid for by the state. Texas Medicaid then covers the prescriptions of these drug manufacturers for Medicaid participants.

Drug manufacturers are required to report any prescription drugs covered by the Medicaid to the Drug Rebate program. The state of Texas is notified of any newly covered outpatient drugs. Any drugs that are prescribed by a doctor that are reviewed but not part of the rebate program require pre-authorization. Drug manufacturers are also required to enter into agreement with two other Federal programs in order for Texas Medicaid to cover their prescription drugs, as well as follow a pricing agreement set by the Health Resources and Services Administration and a master agreement set by the Secretary of Veteran Affairs.

These drug rebates are paid by drug manufacturers four times a year to the state of Texas in order to cover needed drugs on the TX Medicaid healthcare plan. The rebates are shared between states and the federal government in order to cover costs of prescription drugs under Medicaid. This drug rebate program allows the state of Texas to receive federal funds for outpatient prescriptions that are necessary for the health and well-being of residents with Texas Medicaid healthcare coverage.

Prescription drug coverage is especially important to Medicaid participants who are low-income earners or disabled. Many TX Medicaid participants are elderly residents that rely on prescription drugs to maintain good health. The Medicaid Drug Rebate program ensures that necessary prescription drugs are accessible to those who need them most. The Texas CHIP Drug Rebate Program is also available to drug manufacturers looking to participate. The Children’s Health Insurance Program (CHIP) is a Medicaid program that provides insurance to children in families that make too much money to receive Medicaid, but cannot afford private insurance. Children covered under CHIP in Texas are provided with necessary prescriptions needed to maintain health and well-being.


What are benefits for Texas residents?

The State of Texas offers a wide array of benefits and services to the residents of Texas at home and abroad. These benefits include health care, housing assistance, unemployment assistance and a variety of programs for families to assist with food and health expense. Many individuals and families qualify for several of these programs. Complete the survey and download our guide to find helpful information on all of Texas Benefits along with details about eligibility and instructions for how to apply here.


Who is eligible for Texas benefits?

The State of Texas extends benefits to those who qualify. Families, individuals who have lost their job, persons with disabilities and elderly residents are usually those who will benefit the most from Texas’s social welfare programs. For a comprehensive list of the requirements for each of Texas’ programs please complete the survey and download our guide.