NC Medicaid to Remove Copays for HIV Antiretroviral Medications

Effective Nov. 1, 2023, NC Medicaid will remove all copay requirements for antiretroviral medications which decrease viral load in patients with HIV.

Effective Nov. 1, 2023, in preparation for the launch of NC Medicaid Expansion, NC Medicaid is removing copayment requirements for HIV antiretroviral (ARV) medications provided through the Outpatient Pharmacy benefit for all NC Medicaid beneficiaries. This change applies to both NC Medicaid Direct and NC Medicaid Managed Care.

Currently, an eligible Medicaid beneficiary who receives prescribed drugs is required to pay a $4 copay for each prescription received unless they are exempt for one of the reasons listed in the Outpatient Pharmacy Clinical Coverage Policy No. 9, which is available on the Program Specific Clinical Coverage Policies page.

This new exemption, effective Nov. 1, 2023, would apply to all approved ARVs used to treat HIV, which are provided through the Outpatient Pharmacy benefit. This policy change supports public health efforts to reduce the transmission of HIV.


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