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:
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