SPECIAL BULLETIN COVID-19 #44: Pharmacy Claims Flexibility Available to Prevent Spread of Coronavirus Disease (COVID-19)

Tuesday, April 14, 2020

Given the presence of the COVID-19 virus in North Carolina, point of sale pharmacy claims processing flexibility has been instituted to help reduce the administrative burden of providing appropriate medications in a timely fashion to NC Medicaid and NC Health Choice beneficiaries. 

In addition, these measures can help accommodate appropriate social distancing measures. We encourage prescribers and pharmacies to utilize these flexible options as we assist our beneficiaries in managing their drug therapies during this public health issue.
Beginning April 6, 2020, NC Medicaid and NC Health Choice beneficiaries may fill prescriptions for up to 90 days supply for:

  • Schedule 2 medications typically prescribed for Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (i.e. Adderall XR, amphetamine combo, methylphenidate, Vyvanse, etc.)
  • Medications prescribed for Opioid Use Disorder Medication Assisted Treatment and paid for via the point of sale outpatient pharmacy program (i.e. Suboxone, etc.)
  • Medical providers are encouraged to write prescriptions for up to 90 days supply of these medications where clinically appropriate so beneficiaries may utilize this important benefit.
  • Please be aware that these edit changes do not apply to any other controlled substances. Additionally, we encourage providers to follow all applicable state and federal laws and regulations for controlled substances.
  • Refer to the Special Pharmacy Newsletter dated March 13, 2020, for a listing of other flexibilities initiated, including allowing up to 90 days supply of most non-controlled substance medications

Co-pay requirements are still applicable to these pharmacy claims. 

We are monitoring potential drug shortages daily. Providers may submit any information related to market shortages of medications directly to DHB staff at Medicaid.PDL@dhhs.nc.gov

These flexibilities are in effect beginning April 6, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.

GDIT, (800) 688-6696