Recent court rulings now require the North Carolina Department of Health and Human Services to reverse provider rate reductions and restore rates to their Sept. 30, 2025, levels.
Topics Related to Pharmacy 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).
Flexibilities effective Sept. 26, 2025, for NC Medicaid beneficiaries due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).
Effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity will be discontinued.
Flexibilities effective Aug. 19, 2025, for NC Medicaid beneficiaries due to Hurricane Erin
Effective with date of service Aug. 1, 2025, NC Medicaid covers benzathine benzylpenicillin (Extencilline®) and benzathine benzylpenicillin tetrahydrate (Lentocilin).