Effective Oct. 1, 2021, Session Law 2021 – 110 House Bill 96 authorizes immunizing pharmacists to administer Long Acting Injectable (LAI) medications to persons at least 18 years of age pursuant to a specific prescription order initiated by a prescriber.
In addition to the Administration of Long-Acting Injectables Pharmacy Rule, the North Carolina Board of Pharmacy has created a guidance document summarizing the new authority, how pharmacists may exercise it, and responsibilities should they choose to administer these long acting injectable medications.
Effective Nov. 1, 2021, the administration of LAIs to North Carolina Medicaid and NC Health Choice beneficiaries is eligible for reimbursement of an administration fee billable through the outpatient point of sale pharmacy benefit.
- For NC Medicaid Direct point of sale claims, pharmacies must input a Level of Service (Field 418-DI) indicator equal to 05 on the POS pharmacy claim of the drug being administered for payment of the administration fee when applicable.
- The administration fee will be paid at a rate of $17.36.
- There is a limit of one administration fee paid per claim.
- The administration fee will not be paid on IHS/Tribal pharmacy claims paid at the OMB flat rate.
- Appropriate claims from Oct. 1, 2021, may be retroactively submitted to include this code if the drug was administered pursuant to this new law. An administration fee may be paid on a compound drug claim if one or more paid injectable medications are found on the claim.
- Pharmacies cannot request an emergency supply, mailing fee or delivery fee on the same claim submitted with an LAI administration fee reimbursement indicator.
A POS message will return to the pharmacy for all claims billing the administration fee to alert the provider whether the administration fee was paid or not paid. No administration fee will be paid for denied claims.
These claim filing instructions are to adjudicate LAI administration fees for NC Medicaid Direct claims ONLY. Managed care claims to pay an LAI administration fee will be through other point of sale methods. Contact the managed care plan directly to inquire.
NC Medicaid will monitor this fee usage and may update these guidelines at any time.
Contact
NCTracks Call Center: 800-688-6696