Prior Authorization for Physician Administered Drug Program
Not required for medications administered at the provider’s office or outpatient hospital clinic settings and billed as part of the professional claim (Physician Administered Drug Program)

Not required for medications administered at the provider’s office or outpatient hospital clinic settings and billed as part of the professional claim (Physician Administered Drug Program).

As a reminder, medications administered at the provider’s office or outpatient hospital clinic settings and billed as part of the professional claim (Physician Administered Drug Program) do NOT require Prior Authorization (PA) for either NC Medicaid Direct or NC Medicaid Managed Care health plans. Individual drug billing guidelines should be followed as found on the Medicaid website. Completing a PA will not ensure payment of the drug.

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NCTracks Call Center: 800-688-6696

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