This bulletin updates the previously published NC Medicaid Direct Pharmacy Benefits Administrator Provider Transition Overview and Webinars bulletin.
Topics Related to Division of Health Benefits
NC Medicaid providers must accurately answer all Exclusion Sanction questions.
Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.
Evaluates the influence of NC Medicaid Transformation on primary care and obstetrics/gynecology practices that contract with NC Medicaid.
The Department is no longer requiring compliance with Tobacco-free Campus Policy Requirements by Jan. 1, 2027.
The North Carolina Department of Health and Human Services (NCDHHS) reminds pharmacy providers that Prime Therapeutics State Government Solutions LLC (Prime Therapeutics) will serve as the Pharmacy Benefits Administrator (PBA) for NC Medicaid Direct point-of-sale (POS) pharmacy benefits beginning May 2, 2026.
Applications must be submitted no later than March 22, 2026, at 11:59 p.m.
An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.
For NC Medicaid and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State Funded Behavioral Health Providers.
NOTE: This change applies only to NC Medicaid Direct beneficiaries. There is no impact to beneficiaries enrolled in NC Medicaid Managed Care.
OverviewThe North Carolina Department of Health and Human Services (NCDHHS) is transitioning Pharmacy Benefit Administrator (PBA) services for NC Medicaid Direct. Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the PBA for NC Medicaid Direct pharmacy claims.