Texas Health and Human Services Commission Medicaid/ CHIP Vendor Drug Program--Desk Reviews of Compound Drug Claims

Desk Reviews

Desk reviews are conducted monthly for the purpose of monitoring compliance of three types of paid outpatient pharmacy claims:

• High Dollar claims (total paid is equal to or greater than $1500.00)
• Maximum Allowable Cost (MAC) claims (physician override reported, and total paid is greater than $30)
• Compound drug claims

Claims are selected for review at the discretion of Vendor Drug Program regional pharmacists.

Learn what compound drug claims must contain here