The Medicaid Lock-In Program is a health and safety program that protects Members whose use of drug store (pharmacy) services goes beyond what is medically necessary.

If you have Medicaid, you may be put in the Lock-in Program if you do not follow Medicaid rules. This means you must get all of your medications from only one pharmacy. All of your Medicaid benefits will stay the same.

If you are placed in the Lock-in Program, you will get a letter from the Office of Inspector General (OIG) notifying you of the name of the pharmacy you are locked into and the start date. The name of your pharmacy will also be on “Your Texas Benefits” Medicaid ID card. You must show “Your Texas Benefits” Medicaid ID card to get Medicaid medicines and use that pharmacy for Community First Health Plans to pay for your medicines.

How Long Will I Be Locked In?

Lock-ins may range from 36 to 60 months.
The OIG will look at the way you have been using your Medicaid benefits near the end of the lock-in period to see if you will stay locked for a longer time.

What if I move?

If you move more than 15 miles away from your Lock-in pharmacy, call Community First to let us know your new address and the name, address, and phone number of the new pharmacy you want.
Call “211” (pick a language and then pick option 2) to report your new address and phone number to Texas HHSC.
If you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), call the Social Security office at 1-800-772-1213.

What If I Go To A Pharmacy That Is Not My Lock-In Pharmacy

If you go to a pharmacy that is not the one on “Your Texas Benefits” Medicaid ID card, your medicine will not be covered. You will have to pay for the medicine yourself.

When Can I Go To A Pharmacy That Is Not My Lock-In Pharmacy

When the Lock-in pharmacy does not have the medicine prescribed and cannot get it within 2-3 days, or
When you moved more than 15 miles away from your Lock-in pharmacy and have not selected a new Lock-in pharmacy, or
When the Lock-in pharmacy is closed.

Please contact Community First Health Plans by calling the Member Services number on the back of your Member ID card. We will review your request and provide assistance.

What if I change Medicaid health plans?

Changing Medicaid health plans will not take you off the Lock-in Program before the end of the 36 or 60 months.

What do I do if I have More questions?

For Medicaid benefits, call 211 (pick a language and then pick option 2) for information about Medicaid.
For pharmacy benefits, call Community First Member Services at 1-800-434-2347.

Additional Sources
What You Need to Know About The Lock-in Program (English & Spanish)