Updates to Pharmacy Prior Approval Submissions

On Jan. 28, 2018, the NC Department of Health and Human Services (DHHS) implemented updates to NCTracks pharmacy prior approval (PA) requests for North Carolina Medicaid and NC Health Choice beneficiaries. New electronic PA submissions are available for the following drugs and the temporary fax forms were removed:

• Immunomodulators (fax requests will no longer be accepted after January 27)
• PCSK9 Inhibitors (fax requests will no longer be accepted after January 27)
• Daklinza (added to the Hep C web submission. Fax requests will no longer be accepted after January 27)
• Nucala (fax requests will no longer be accepted after January 27)
• Entresto (fax requests will no longer be accepted after January 27)
• Orkambi (added to the Cystic Fibrosis web submission and fax form)​
• Xolair for Chronic Idiopathic Urticaria (Web submission and fax form available)

Although submission requirements are updated, the PA criteria will remain the same. With the new electronic PA request submissions for these drugs, the previous temporary fax forms are no longer accepted.

For additional information, refer to the Drug Request Forms and Prior Approval Drugs and Criteria web pages under Pharmacy Services on the public NCTracks Provider Portal. A Job Aid for the Sterilization Consent Form also can be found on the NCTracks User Guides and Training web page.

Instructions for submitting a pharmacy PA on the secure NCTracks Provider Portal can be found in section 3 of the PA 341_Prior Approval Medical Participant User Guide in SkillPort. Refer to the Provider Training page of the public Provider Portal for specific instructions on how to use SkillPort. The Provider Training page also includes a quick reference regarding downloading Java, which is required for the use of SkillPort.