Effective Aug. 1, 2024, NC Medicaid is removing copayment requirements for opioid antagonists, nicotine replacement therapy and medications used to treat opioid use disorder. This change applies to both NC Medicaid Direct and NC Medicaid Managed Care beneficiaries who are covered under the Outpatient Pharmacy benefit.
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.
The exemption, effective Aug. 1, 2024, helps to ensure beneficiaries living with nicotine dependence or opioid use disorder (including emergency treatment of known or suspected opioid overdose) do not face financial barriers when obtaining these medications from outpatient pharmacies. Additionally, this exemption supports public health efforts to increase access to substance use disorder treatment.
Contact
NCTracks Call Center: 800-688-6696