This bulletin updates the previously published NC Medicaid Direct Pharmacy Benefits Administrator Provider Transition Overview and Webinars bulletin.
Topics Related to All Providers
NC Medicaid providers must accurately answer all Exclusion Sanction questions.
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.
An out-of-date NCTracks provider record jeopardizes continued NCDHHS program participation.
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.
Flexibilities extended through Feb. 6, 2026, for NC Medicaid beneficiaries due to additional Winter Storm weather.
Information on Required Provider Disclosures, Children and Families Specialty Plan Flexibilities, Case Manager/Care Coordinators Updates and more.
Flexibility extended to Jan. 30, 2026, for NC Medicaid beneficiaries due to Winter Storm.