Overview
The North Carolina Department of Health and Human Services (NCDHHS) reminds pharmacy providers that Prime Therapeutics State Government Solutions LLC (Prime Therapeutics) will serve as the Pharmacy Benefits Administrator (PBA) for NC Medicaid Direct point-of-sale (POS) pharmacy benefits beginning May 2, 2026. This transition applies only to POS pharmacy claims and does not include medical pharmacy claims.
Effective May 2, 2026
NC Medicaid Direct POS pharmacy claims will be submitted by pharmacy providers to Prime Therapeutics beginning May 2, 2026. Prime will use BIN (610242) and PCN (781640064) for NC Medicaid Direct POS pharmacy claims, which are the same BIN and PCN number used today for NCTracks.
- This transition ONLY impacts beneficiaries enrolled in NC Medicaid Direct.
- There is no impact on members enrolled in NC Medicaid Managed Care health plans.
Upcoming NC Medicaid Direct PBA Pharmacy Provider Webinars
| Date | Time | Location | Topic | Meeting Link |
|---|---|---|---|---|
| March 20 | Noon to 1:30 p.m. (ET) | Virtual via Microsoft Teams | Overview of New Prime Therapeutics PBA for NC Medicaid Direct Point of Sale Pharmacy | Register Here |
| April 20 | 6 to 7:30 p.m. (ET) | TBD | Deeper dive into the PBA for providers, including a demonstration of the Prime Therapeutics system and addressing frequently asked questions | Coming soon |
Provider Preparation
Accessing the PBA Portal
Providers can access the PBA–Pharmacy Provider Portal by selecting the Pharmacy Benefit Administrator tile on the Medicaid Enterprise System portal.
Before May 2, 2026, providers do not need to log in to view the following information:
- PBA updates
- Announcements
- Training materials
- Resources
Additional guidance will be available under the Library section prior to Go Live. More information is available on the NC Medicaid Pharmacy Benefit Administrator web page.
System Transition and Downtime
There will be a brief scheduled system downtime for NCTracks from May 1, 2026, 11:45 p.m. to May 2, 2026, 12:15 a.m. (ET) to support the transition of point-of-sale (POS) pharmacy claims processing from NCTracks to Prime Therapeutics.
During this time:
- NCTracks will no longer process NC Medicaid Direct POS claims after 11:45 p.m. (ET)
- The POS Pharmacy claims submitted will not process. Providers will need to resubmit the claims after 12:15 a.m. (ET) on May 2, 2026.
- Prime will begin processing NC Medicaid Direct pharmacy claims at 12:15 a.m. (ET) on May 2, 2026.
Claims and Prior Authorization Transition Guidance (Effective May 2, 2026)
- All current and historical claims and prior authorizations will be transferred to Prime Therapeutics prior to May 2, 2026.
- All new prior authorization requests on or after May 2, 2026, must be submitted directly to Prime Therapeutics.
- Submission options include:
- Telephone Call Center: (844) 620-6116, Available: 24 hours / 7 days a week / 365 days a year
- Web Support: Monday – Friday, 8 a.m. – 8 p.m. (ET)
- Fax Number: (866) 422-8981
- Mail: Prime Therapeutics State Government Solutions, LLC
Attn: GV
P.O. Box 64811
St. Paul, MN 55164-0811 - Electronic prior authorization (ePA) via CoverMyMeds®
Prior Authorization Processing
Prime Therapeutics will process Prior Authorization submissions 24 hours per day, 7 days per week, 365 days a year beginning May 2, 2026.
Emergency Supply Guidance
Pharmacies should continue to dispense a 72-hour emergency supply when:
- A medication requires prior authorization
- The prescriber cannot be reached, and
- Delay in therapy could result in patient harm
Pharmacy Resources and Drug Look Up Tool
Providers may access pharmacy resources including:
- NC Single State Preferred Drug List
- Drug Lookup Tools
- Prior authorization criteria
- Provider training materials
These resources will be available on the Medicaid Enterprise System portal.
Payer Sheet
The Payer Specification Sheet is a document that gives pharmacy providers all the information they need to successfully submit POS pharmacy claims to the PBA. This is available on the North Carolina Medicaid Pharmacy Portal.
The Payer Specification Sheet will detail required claim submission fields and specifications to assist with proper claim filing. Pharmacies are encouraged to coordinate with their software vendor to ensure system readiness prior to Go-Live.
Pharmacy Claims Processing
Beginning May 2, 2026, Prime Therapeutics will use the existing BIN and PCN numbers previously utilized by NCTracks.
| Plan | Corresponding Processor | BIN Number | PCN | Group Number | Contact Information |
|---|---|---|---|---|---|
| NC Medicaid Direct | Prime Therapeutics | 610242 | 781640064 | N/A | (844) 620-6116 Available starting May 2, 2026 |
Pharmacy Provider Training
Prime Therapeutics will provide self-paced virtual training videos to support provider readiness. Training materials will be available on March 20, 2026.
Providers are encouraged to complete the following trainings prior to May 2, 2026:
More information will be available under Links on the North Carolina Medicaid Pharmacy Portal, accessible through the Medicaid Enterprise System portal.
Pharmacy Switch Vendor Testing
NC enrolled Pharmacy providers are encouraged to submit test claims prior to the PBA launch on May 2, 2026, to confirm system connectivity and readiness.
Testing Registration
To register for testing and receive test claim details (including test member information), email: PharmacyTesting@primetherapeutics.com.
Please include the following information:
- Contact Name
- Contact Phone Number
- Pharmacy National Provider Identifier (NPI)
- Switch Vendor Information
Testing Window
The testing window is March 16 – April 17, 2026. Testing ends on April 17, 2026.
Test Claim Parameters
The following National Council for Prescription Drug Programs (NCPDP) transaction header segment values must be used for test claim submission:
NOTE: Payer Usage column:
- M = Mandatory, and
- R = Required
Important
Use only the testing BIN (022618) during the testing period. The testing BIN is valid only during the testing window of March 16, 2026, through April 17, 2026. Test claims submitted using the production BIN may result in claim rejections or processing errors.
Pharmacies that participate in testing should ensure the production BIN is restored after testing.
DO NOT submit any test claims using the production BIN (610242).
Support and Contact Information
Prior to May 2, 2026, providers should continue to contact NCTracks for assistance at 800-688-6696. Beginning May 2, 2026, pharmacies may contact the Prime Therapeutics Pharmacy Call Center at 844-620-6116 for assistance with:
- General pharmacy support
- Medication dispensing questions
- System access issues
The Prime Therapeutics Pharmacy Call Center is available 24 hours per day, 7 days per week, 365 days a year, beginning May 2, 2026.