SPECIAL BULLETIN COVID-19 #216: Pharmacies Will Cover Oral Tablets (Paxlovid and Molnupiravir) Oral tablets covered for those in a home setting

Effective Jan. 1, 2022, NC Medicaid-enrolled pharmacies may bill for FDA/EUA-approved COVID-19 oral tablets (Paxlovid and/or Molnupiravir) dispensed for use to NC Medicaid beneficiaries in a home setting, with a prescription issued by an NC Medicaid-enrolled provider (refer to beneficiaries’ managed care plan for guidance on the specific plan’s implementation date).

• NC Medicaid will cover one claim per date of service per beneficiary.
• The claim must have a prescribing provider. 
• Pharmacies must follow the NCPDP standard and use the NDC found on the package.
• Pharmacies will be NOT be reimbursed for the ingredient cost since the drugs are federally provided at no cost. 
• Dispensing fee will apply.
• Copayment will not apply.

For more information, see FDA letters:

• Paxlovid EUA
• Molnupiravir EUA

CONTACT

NCTracks Contact Center: 800-688-6696