NOTE: This change applies only to NC Medicaid Direct beneficiaries. There is no impact to beneficiaries enrolled in NC Medicaid Managed Care.
Overview
The North Carolina Department of Health and Human Services (NCDHHS) is transitioning Pharmacy Benefit Administrator (PBA) services for NC Medicaid Direct. Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the PBA for NC Medicaid Direct pharmacy claims.
Transition Objectives
The transition to a new Pharmacy Benefit Administrator supports NC Medicaid Direct’s efforts to:
- Improve the efficiency and reliability of pharmacy claims processing while supporting cost management aligned with the State’s Preferred Drug List
- Enhance beneficiary access to medications and promote medication safety and quality through clinical oversight and utilization review
- Provide education, tools and support resources to pharmacies, providers and beneficiaries throughout the transition
What has Changed
- NCTracks will no longer process NC Medicaid Direct Point of Sale pharmacy claims after May 1, 2026.
- Effective May 2, 2026, all NC Medicaid Direct pharmacy claims must be submitted through Prime’s pharmacy claims system.
- The NEW Pharmacy Call Center phone number will be 844-620-6116 and will open May 2, 2026, at midnight.
What has Not Changed
Prime will utilize the existing NCTracks BIN and PCN to minimize any impact to point of sale pharmacy claims processing.
Provider Preparation
In preparation for the transition to the new Pharmacy Benefit Administrator (PBA), pharmacy providers are encouraged to take the following actions:
Stay Informed
- Review the NC Medicaid Provider webpage regularly and monitor NC Medicaid Bulletins for updates and additional guidance related to NC Medicaid Direct pharmacy services.
- Training and educational resources will be communicated through the PBA Pharmacy Provider Portal, accessible via the NC Medicaid Enterprise System (MES) Landing Page.
Prepare Systems and Workflow
Coordinate with pharmacy software vendors and internal staff to ensure readiness for updated claims submission, prior authorization and drug utilization review processes effective May 2, 2026.
Upcoming Provider Webinars
To support provider readiness, NC Medicaid and Prime will host two provider education webinars in March and April to review the PBA transition and address frequently asked questions.
Upcoming PBA Informational Webinars for Providers
| Date | Time | Topic | Meeting Link |
|---|---|---|---|
| March 20, 2026 | noon to 1:30 p.m. | Overview of New Prime PBA system for NC Medicaid Direct Point of Sale Pharmacy | Follow this link to join meeting |
| April (week of April 20, 2026 -TBD) | TBD | Deeper dive into the PBA for providers, including a demonstration of the Prime system and addressing frequently asked questions | Coming soon |
Transition Resources
Detailed resources will be made available on the PBA Pharmacy Provider Portal, accessible through the NC Medicaid Enterprise System (MES) landing page.
Information on the portal will include:
- Pharmacy testing
- Training materials
- Claim submission requirements
- System support
Providers do not need to Login to access public PBA-related announcements and resources prior to Go-Live.
Training and Testing
Prime, in coordination with NCDHHS, will offer pharmacy testing and training opportunities prior to Go-Live to support provider readiness and confirm system connectivity.
Additional details will be communicated through the PBA Pharmacy Provider Portal, accessible through the NC MES Portal.
NCDHHS appreciates the continued partnership of NC Medicaid Direct pharmacy providers during this transition.