Adult Vaccines Added to the Pharmacy Benefit in 2026

Date: October 14, 2025

Attention: Providers

Effective date: February 2, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that beginning February 2, 2026, the Vendor Drug Program will offer adult vaccines as a pharmacy benefit to increase access to recommended adult vaccines. The Medicaid medical benefit already covers these vaccines.

How this impacts providers: The addition of the vaccines for adults ages 19 and up through the pharmacy benefit includes the NDCs with a link to the list available here. The adult vaccines will be included on the MCO/TCHP daily formulary (ACSPTFF) and DEL file (ACSPDEL) for Medicaid as a payable pharmacy benefit, effective January 2026.

Refer to the updated Pharmacy Vaccine Coverage chart below, which includes adult vaccine coverage through the pharmacy benefit.

Pharmacy-Administered Vaccine Category	Pharmacy Benefit Coverage Policy
COVID vaccines for ages 3 to 18	These are not covered by the Texas Medicaid pharmacy benefit. They may be transacted and reimbursed through the Vaccines for Children program.
COVID vaccines for ages 19 and older	MCOs must allow through the Medicaid pharmacy benefit, including the cost of the vaccine and administration fee.
Flu vaccines for ages 3 to 18	MCOs must allow through the Medicaid pharmacy benefit, including the cost of the vaccine and administration fee.
Flu vaccines for ages 19 and older	MCOs must allow through the Medicaid pharmacy benefit, including the cost of the vaccine and administration fee.
All other vaccines for ages 14 to 18	These are not covered by the Texas Medicaid pharmacy benefit. They may be transacted and reimbursed through the Vaccines for Children program. (See state pharmacy law/Texas State Board of Pharmacy for age limits on pharmacist vaccine administration.)
“Adult Vaccines” for ages 19 and older	Starting Feb. 2, 2026, MCO must allow through the Medicaid pharmacy benefit, including the cost of the vaccine and the administration fee. This applies to the vaccines listed on the VDP formulary starting Jan. 2026.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.