NC Medicaid Managed Care plans may apply utilization edits and/or prior authorization criteria per the Food and Drug Administration label on drugs when the State has not established criteria and has not prohibited use of criteria.
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NC Medicaid is providing updated information to providers about the federal prohibitions on certain providers.
This guidance is based on the NC Immunization Program/Vaccines for Children guidelines.
This guidance is based on products approved by the FDA and recommended by the CDC Advisory Committee on Immunization Practices.
Wegovy and Zepbound for indications other than weight loss to be covered based on the indications and usage criteria published in the FDA label, pending updated clinical criteria.
The five-year cost of dispensing survey has been completed for North Carolina pharmacies.
Effective Oct. 1, 2025, NC Medicaid will no longer cover the prescription drug Xifaxan (Rifaximin).
Providers can no longer bill NC Medicaid for Hospital at Home for dates of service on or after Oct. 1, 2025.
Flexibilities effective Sept. 26, 2025, for NC Medicaid beneficiaries due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).
Current Procedural Terminology (CPT) code 99177, Screening of Eye with Special Instrument Onsite Analysis is separately reimbursable effective Nov. 1, 2024.