Pharmacy Newsletter_March 2026
An Information Service of the Division of Health Benefits
NC Medicaid Pharmacy Newsletter
Number 388 March 2026
In This Issue...
Published by GDIT, fiscal agent for the North Carolina Medicaid Program 800-688-66
New Pharmacy Benefit Administrator (PBA) for NC Medicaid Direct
The North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB), 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 claims beginning May 2, 2026.
Pharmacy Provider Webinar for new PBA for NC Medicaid Direct
Join NC Medicaid and Prime Therapeutics for two provider webinars on an overview of the NC Medicaid Direct Pharmacy Program transition. This webinar will review important information for pharmacy providers, including operational updates, implementation timelines, and resources available ahead of May 2, 2026, Go-Live date.
| Date | Time | Location | Topic | Meeting Link |
|---|---|---|---|---|
| March 20 | 12 PM to 1:30 PM ET | Virtual | Overview of New Prime Therapeutics PBA system for NC Medicaid Direct Point of Sale Pharmacy | REGISTER HERE |
| April (week of 4/20 -TBD) | TBD | Virtual | Deeper dive into the PBA for Providers, including a demonstration of the Prime Therapeutics system and addressing frequently asked questions. | Coming soon |
System Transition and Downtime
To support a seamless transition, Prime Therapeutics will assume responsibility of the BIN (610242) and PCN (781640064) previously utilized by NCTracks. Any pharmacy POS claim submitted to BIN 610242 and PCN 781640064 will be automatically routed to Prime Therapeutics without any action from pharmacy providers beginning on Saturday, May 2, 2026.
This transition ONLY applies to NC Medicaid Direct POS pharmacy claims
- There is no impact to NC Medicaid Direct medical claims
- There is no change for members enrolled in NC Medicaid Managed Care health plans
There will be a brief scheduled system downtime for NCTracks from May 1, 2026, 11:45 PM to May 2, 2026, 12:15 AM to support the transition of POS pharmacy claims processing from NCTracks to Prime Therapeutics.
During the scheduled downtime:
- NCTracks will no longer process NC Medicaid Direct POS claims after 11:45 PM on Friday May 1, 2026.
- Prime Therapeutics will begin processing NC Medicaid Direct POS claims after 12:15 AM on Saturday May 2, 2026
Pharmacy Providers Encouraged to Participate in Switch Vendor Testing
As part of the transition, the new PBA system has been configured to fully align with existing NC Medicaid pharmacy claims submission policy requirements. To support a smooth Go-Live and minimize any disruption, NC Medicaid strongly encourages pharmacies to participate in switch vendor testing. Testing enables pharmacies to confirm that their systems are configured correctly, validate claim responses, and ensure claims, particularly Coordination of Benefits (COB) scenarios are submitted in accordance with current policy and processes. It also provides an opportunity to identify and resolve any issues in advance.
We understand the operational demands pharmacies face, and testing has been designed to be quick, flexible, and manageable within your daily workflow.
Testing Expectations
At a minimum, pharmacies are encouraged to submit:
- One paid claim (B1)
- One reversal (B2)
- One COB or compound claim, if pharmacy workflow supports
Testing Window: March 16, 2026, to April 17, 2026
To register for testing and receive test claim information, please email Prime Therapeutics at: PharmacyTesting@primetherapeutics.com
Please include the following information in your email:
- Contact Name
- Contact Phone Number
- Pharmacy National Provider Identifier (NPI)
- Switch Vendor Information
Once registered, Prime Therapeutics will provide test member details and remain available to support pharmacies throughout the testing process.
Please note that this testing applies only to NC Medicaid Direct and does not impact NC Medicaid Managed Care.
Provider Preparation
Accessing the PBA Portal:
Providers can access the PBA Pharmacy Provider Portal by selecting the Pharmacy Benefit Administrator tile at: https://mes.medicaid.ncdhhs.gov/
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 also available at: https://medicaid.ncdhhs.gov/providers/programs-and-services/prescription-drugs/pharmacy-benefit-administrator
Self Guided Pharmacy Provider Training
Prime Therapeutics will provide self-paced virtual training videos to support provider readiness.
Providers are encouraged to complete training prior to May 2, 2026.
North Carolina Provider Implementation Training
North Carolina Web Portal Demo (Providers)
More information will be available under Links on the PBA Portal: NC Medicaid Pharmacy Benefit Administrator webpage via the MES portal at https://mes.medicaid.ncdhhs.gov.
Opill Without a Prescription Pharmacy Coverage
Over the counter oral contraceptive Opill is available without a prescription, at no cost.
NC Medicaid beneficiaries may obtain the over the counter (OTC) oral contraceptive Opill without a prescription and at no cost. While NC Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment, or even a lack of health care providers in the community. Medicaid beneficiaries will be able to get Opill from pharmacies enrolled in Medicaid who will be able to submit the claim for reimbursement.
Coverage for NC Medicaid Managed Care Beneficiaries
This benefit, effective Aug. 1, 2024, applies to both NC Medicaid Direct beneficiaries and NC Medicaid Managed Care members. Claims for Opill without a prescription for all NC Medicaid beneficiaries, including NC Medicaid Direct and NC Medicaid Managed Care, should be adjudicated through NCTracks. The NC Medicaid Managed Care pharmacy benefit will not be utilized to process claims for Opill without a prescription.
NCTracks Claims Processor Information is below for Opill without a prescription.
| Enrollment | Claims Processor | Bin Number | PCN Number | Group Number |
|---|---|---|---|---|
| NC Medicaid Direct Beneficiaries | NCTracks | 610242 | 781640064 | N/A |
| NC Medicaid Managed Care Members | NCTracks | 610242 | 781640064 | N/A |
Please note: Opill is also covered with a prescription. For Opill with a prescription, pharmacies should continue to bill the beneficiary’s managed care plan if they are enrolled in managed care.
Pharmacy Providers
For Opill to be covered without a prescription by NC Medicaid, pharmacy providers should:
- Process all claims for Opill without a prescription through the NCTracks BIN, PCN and group number noted in the table above.
- Submit the claim using the pharmacy NPI as the prescriber to identify the claim is billing for “Opill without a prescription” coverage. The claim will be denied with a message back to pharmacy, instructing the pharmacy to “resubmit the claim using “P0” (P zero) as the edit override code.”
- Resubmit the claim using Professional Service Code “P0” to override edit 07006
A $5.00 fee will be included in the reimbursement amount paid to the pharmacy. A dispensing fee will not be paid. Beneficiaries are allowed to obtain up to a 3-month supply of Opill with each request, without a prescription, with a maximum of 13 packs per year. Opill is a progestin only contraceptive. Pharmacists should counsel beneficiaries that Opill is most effective when taken once a day at the same time each day.
Pharmacy providers are permitted and encouraged to post signage in the pharmacy to inform Medicaid beneficiaries that Opill is available at no cost, without a prescription.
Taxonomy: Review for Accurate Screening
An outdated NCTracks provider record jeopardizes continued NCDHHS program participation.
Providers must regularly review the taxonomies listed on their records to ensure that each one accurately represents services currently offered to NC Medicaid beneficiaries. Because pharmacy providers are subject to site visits, inaccurate or outdated taxonomy data puts the pharmacy at risk of a failed site visit, resulting in a for-cause termination from NCDHHS programs.
The recently published bulletin article, Risks of Not Accurately Reporting on Your NCTracks Provider Record, identifies the following risks of having an incorrect taxonomy active on the pharmacy’s record:
Failed Site Visit/Termination:
For NC Medicaid providers, site visits are conducted by Public Consulting Group (PCG). As required by 42 CFR 455.432, NC Medicaid must conduct pre-enrollment and post-enrollment site visits for Moderate and High categorical risk taxonomies. These visits are performed to verify that the information submitted to NC Medicaid is accurate and compliant with federal and state requirements.
PCG reviews active taxonomies on the provider record and validates that each accurately reflects the service rendered by the provider. If during a site visit the
provider cannot demonstrate basic knowledge of expected services, the site visit is registered as a “fail.” This result is communicated to GDIT and causes an automatic for-cause termination of participation. Maintaining accurate taxonomies on the provider record helps to ensure that the correct screening takes place.
Inaccurate Provider Directories:
NC Medicaid and all NC Medicaid Managed Care health plans publish provider directories which include information about available services based on active taxonomies. Incorrect data risks beneficiaries seeking services not available at the provider’s location, wasting time and effort for both the provider and the beneficiary.
Pharmacy providers may review and update their provider enrollment record data through the NCTracks Manage Change Request, available on the secure NCTracks Provider Portal Status and Management webpage.
Additional Resources
- The Provider Permission Matrix (PPM) and instructions for using the PPM are located under Quick Links on the NCTracks Provider Enrollment webpage
- User guides for How to View and Update Taxonomy and How to Select a Taxonomy Code are located on the NCTracks User Guides & Fact Sheets webpage under the Taxonomy section
- NCTracks General Provider Enrollment FAQs
- Manage Change Request FAQs
- Provider Site Visits Valid for Five Years announcement
Contact
- NCTracks Call Center: 800-688-6696
- Provider Ombudsman: 866-304-7062
Eastern Band of Cherokee Indians Tribal Option and Pharmacy Billing
The Eastern Band of Cherokee Indians (EBCI) Tribal Option is an Indian Managed Care Entity. As a NC Medicaid health plan, the EBCI Tribal Option provides managed care for federally recognized Tribal members and other individuals eligible to receive Indian Health Services. Beneficiaries reside in Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain, and Transylvania counties. Any NC Medicaid provider may render services to EBCI Tribal Option beneficiaries.
As a reminder, pharmacy claims for Tribal Option members are billed through Medicaid Direct (NCTracks currently). Providers are not permitted to collect copayments from ECBI Tribal Option beneficiaries and pharmacy claims should return with a $0 copay amount due from the beneficiary. For assistance with eligibility issues for ECBI Tribal Option beneficiaries, providers can call 800-260-9992.
If a Tribal member is enrolled in a health plan such as the Standard Plan, Tailored Plan or the Child and Family Specialty Plan (CFSP), then the claim should be billed using the BIN for that plan. A list of plan BINs is below. Copayments would be collected for this population unless the member has another qualifying exemption.
For assistance with pharmacy point of sale claims, providers can call NCTracks at (866) 246-8505 for members enrolled in NC Medicaid Direct or call the member’s health plan if the member is enrolled in a plan.
NC Medicaid Direct and Standard Plan Benefits Information
| Managed Care Organization | Corresponding PBM Processor | BIN Number | PCN | Group Number | Contact Information |
|---|---|---|---|---|---|
| Fee for Service (Medicaid Direct) | NCTracks | 610242 | 781640064 | N/A | 800-688-6696 |
| AmeriHealth Caritas NC | PerformRx | 019595 | PRX00801 | N/A | 866-885-1406 |
| BCBSNC - Healthy Blue | CarelonRx | 020107 | NC | 8473 | 833-434-1212 |
| Carolina Complete Health | Express Scripts | 003858 | MA | 2ERA | 833-750-4461 |
| United Health Care | Optum Rx | 610494 | 4949 | ACUNC | 855-258-1593 |
| WellCare Health Plans | Express Scripts | 003858 | MA | 2ESA | 866-799-5318 |
Tailored Plan Benefits Information
| Managed Care Organization | Corresponding PBM Processor | BIN Number | PCN | Group Number | Contact Information |
|---|---|---|---|---|---|
| Alliance | Navitus | 610602 | MCD | TPMC | 1-855-759-9300 |
| Partners | CVS Caremark | 025052 | MCAIDADV | RX22AC | 1-866-453-7196 |
| Trillium | Perform Rx | 019595 | PRX10811 | N/A | 1-866-245-4954 |
| Vaya | Navitus | 610602 | MCD | VAYARX | 1-800-540-6083 |
Children and Families Specialty Plan (CFSP)
| Managed Care Organization | Corresponding PBM Processor | BIN Number | PCN | Group Number | Contact Information |
|---|---|---|---|---|---|
| Healthy Blue Care Together | CarelonRx | 020107 | NC | 8473 | 833-777-3788 |
Preferred Brands with Non-Preferred Generics on the Preferred Drug List (PDL)
Current as of March 1, 2026
| Brand Name | Generic Name |
|---|---|
| Advair 100-50 Diskus | Fluticasone-Salmeterol 100-50 |
| Advair 250-50 Diskus | Fluticasone-Salmeterol 250-50 |
| Advair 500-50 Diskus | Fluticasone-Salmeterol 500-50 |
| Advair HFA 115-21 mcg Inhaler | Fluticasone-Salmeterol 115-21 HFA Inhaler |
| Advair HFA 230-21 mcg Inhaler | Fluticasone-Salmeterol 230-21 HFA Inhaler |
| Advair HFA 45-21 mcg Inhaler | Fluticasone-Salmeterol 45-21 HFA Inhaler |
| Alphagan P 0.1% Drops | Brimonidine P 0.1% Drops |
| Alphagan P 0.15% Drops | Brimonidine P 0.15% Drops |
| Anoro Ellipta 62.5-25 mcg Inhaler | Umeclidinium-Vilantero 62.5-25 Inhaler |
| Aptiom 200 mg Tablet | Eslicarbazepine 200 mg Tablet |
| Aptiom 400 mg Tablet | Eslicarbazepine 400 mg Tablet |
| Aptiom 600 mg Tablet | Eslicarbazepine 600 mg Tablet |
| Aptiom 800 mg Tablet | Eslicarbazepine 800 mg Tablet |
| Arnuity Ellipta 100 mcg Inh | Fluticasone Ellipta 100 mcg Inh |
| Arnuity Ellipta 200 mcg Inh | Fluticasone Ellipta 200 mcg Inh |
| Arnuity Ellipta 50 mcg Inh | Fluticasone Ellipta 50 mcg Inh |
| Bethkis 300 mg/4 ml Ampule | Tobramycin Solution 300 mg/4 ml Ampule |
| BiDil 20mg-37.5mg Tablet | Isosorbide DN 20mg/Hydralazine 37.5mg |
| Brilinta 60 mg Tablet | Ticagrelor 60 mg |
| Brilinta 90 mg Tablet | Ticagrelor 90 mg Tablet |
| Briviact 10 mg Tablet | Brivaracetam 10 mg Tablet |
| Briviact 100 mg Tablet | Brivaracetam 100 mg Tablet |
| Briviact 25 mg Tablet | Brivaracetam 25 mg Tablet |
| Briviact 50 mg Tablet | Brivaracetam 50 mg Tablet |
| Briviact 75 mg Tablet | Brivaracetam 75 mg Tablet |
| Butrans 10 mcg/hr Patch | Buprenorphine 10 mcg/hr Patch |
| Butrans 15 mcg/hr Patch | Buprenorphine 15 mcg/hr Patch |
| Butrans 20 mcg/hr Patch | Buprenorphine 20 mcg/hr Patch |
| Butrans 5 mcg/hr Patch | Buprenorphine 5 mcg/hr Patch |
| Butrans 7.5 mcg/hr Patch | Buprenorphine 7.5 mcg/hr Patch |
| Byetta 10 mcg Dose Pen Inj | Exenatide 10 mcg Dose Pen Inj |
| Byetta 5 mcg Dose Pen Inj | Exenatide 5 mcg Dose Pen Inj |
| Celontin 300 mg Cap | Methsuximide 300 mg Cap |
| Cipro 10% Suspension | Ciprofloxacin 500 mg/5 ml Suspension |
| Cipro 5% Suspension | Ciprofloxacin 250 mg/5 ml Suspension |
| Combigan 0.2%-0.5% Eye Drops | Brimonidine-Timolol 0.2%-0.5% |
| Copaxone 20 mg/ml Syr | Glatiramer 20 mg/ml Syr |
| Daytrana 10 mg/9 hr Patch | Methylphenidate 10 mg/9 hr Patch |
| Daytrana 15 mg/9 hr Patch | Methylphenidate 15 mg/9 hr Patch |
| Daytrana 20 mg/9 hr Patch | Methylphenidate 20 mg/9 hr Patch |
| Daytrana 30 mg/9 hr Patch | Methylphenidate 30 mg/9 hr Patch |
| Derma-Smoothe-FS Body Oil | Fluocinolone Body Oil |
| Derma-Smoothe-FS Scalp Oil | Fluocinolone Scalp Oil |
| Diclegis 10-10 DR | Doxylamine Succinate/Pyridoxine HCL 10-10 DR |
| Differin 0.1% Cream | Adapalene 0.1% Cream |
| Differin 0.3% Gel Pump | Adapalene 0.3% Gel Pump |
| Dymista Nasal Spray | Azelastine/Fluticasone Prop Nasal Spray |
| Emflaza 18 mg tablet | Deflazacort 18 mg tablet |
| Emflaza 22.75 mg/ml Susp | Deflazacort 22.75 mg/ml Susp |
| Emflaza 30 mg tablet | Deflazacort 30 mg tablet |
| Emflaza 36 mg tablet | Deflazacort 36 mg tablet |
| Emflaza 6 mg tablet | Deflazacort 6 mg tablet |
| Entresto 24 mg-26 mg Tablet | Sacubitril-Valsartan 24-26 mg |
| Entresto 49 mg-51 mg Tablet | Sacubitril-Valsartan 49-51 mg |
| Entresto 97 mg-103 mg Tablet | Sacubitril-Valsartan 97-103 mg |
| Eprontia 25 mg/ml Soln | Topiramate 25mg/ml Soln |
| Exelon 13.3 mg/24 hr Patch | Rivastigmine 13.3 mg/24 hr Patch |
| Exelon 4.6 mg/24 hr Patch | Rivastigmine 4.6 mg/24 hr Patch |
| Exelon 9.5 mg/24 hr Patch | Rivastigmine 9.5 mg/24 hr Patch |
| Farxiga 10 mg | Dapagliflozin 10 mg |
| Farxiga 5 mg | Dapagliflozin 5 mg |
| Forteo 560 mcg/2.24 ml Pen Inj | Teriparatide 560 mcg/2.24 ml |
| Fycompa 0.5 mg/ml Oral Susp | Perampanel 0.5 mg/ml Oral Susp |
| Fycompa 10 mg Tablet | Perampanel 10 mg Tablet |
| Fycompa 12 mg Tablet | Perampanel 12 mg Tablet |
| Fycompa 2 mg Tablet | Perampanel 2 mg Tablet |
| Fycompa 4 mg Tablet | Perampanel 4 mg Tablet |
| Fycompa 6 mg Tablet | Perampanel 6 mg Tablet |
| Fycompa 8 mg Tablet | Perampanel 8 mg Tablet |
| Kitabis Pak 300 mg/5 ml | Tobramycin Pak 300 mg/5 ml |
| Lotemax 0.5% Eye Drops | Loteprednol 0.5% Eye Drops |
| Myrbetriq ER 25 mg Tablet | Mirabegron ER 25 mg Tablet |
| Myrbetriq ER 50 mg Tablet | Mirabegron ER 50 mg Tablet |
| Natroba 0.9% Topical Susp | Spinosad 0.9% Topical Susp |
| Nexium DR 10 mg Packet | Esomeprazole DR 10 mg Packet |
| Nexium DR 2.5 mg Packet | Esomeprazole DR 2.5 mg Packet |
| Nexium DR 20 mg Packet | Esomeprazole DR 20 mg Packet |
| Nexium DR 40 mg Packet | Esomeprazole DR 40 mg Packet |
| Nexium DR 5 mg Packet | Esomeprazole DR 5 mg Packet |
| Nuvessa Vaginal 1.3% Gel | Metronidazole Vaginal 1.3% Gel |
| Oxtellar XR 150 mg Tabs | Oxcarbazepine ER 150 mg Tabs |
| Oxtellar XR 300 mg Tabs | Oxcarbazepine ER 300 mg Tabs |
| Oxtellar XR 600 mg Tabs | Oxcarbazepine ER 600 mg Tabs |
| OxyContin ER 20mg Tablet | Oxycodone ER 20mg Tablet |
| OxyContin ER 40mg Tablet | Oxycodone ER 40mg Tablet |
| OxyContin ER 80mg Tablet | Oxycodone ER 80mg Tablet |
| Pentasa 500 mg Capsule | Mesalamine ER 500 mg Capsule |
| Pradaxa 110 mg | Dabigatran 110 mg |
| Pradaxa 150 mg | Dabigatran 150 mg |
| Pradaxa 75 mg | Dabigatran 75 mg |
| Premarin 0.3 mg Tablet | Conjugated Estrogens 0.3 mg |
| Premarin 0.45 mg Tablet | Conjugated Estrogens 0.45 mg |
| Premarin 0.625 mg Tablet | Conjugated Estrogens 0.625 mg |
| Premarin 0.9 mg Tablet | Conjugated Estrogens 0.9 mg |
| Premarin 1.25 mg Tablet | Conjugated Estrogens 1.25 mg |
| Promacta 12.5 mg Suspension Pckt | Eltrombopag 12.5 mg Suspension Pckt |
| Promacta 12.5 mg Tablet | Eltrombopag 12.5 mg Tablet |
| Promacta 25 mg Suspension Pckt | Eltrombopag 25 mg Suspension Pckt |
| Promacta 25 mg Tablet | Eltrombopag 25 mg Tablet |
| Promacta 50 mg Tablet | Eltrombopag 50 mg Tablet |
| Promacta 75 mg Tablet | Eltrombopag 75 mg Tablet |
| Protonix 40 mg Suspension | Pantoprazole 40 mg Suspension |
| Provigil 100 mg | Modafinil 100 mg |
| Provigil 200 mg | Modafinil 200 mg |
| Pylera Capsules | Bismuth-Metro-Tetr 140-125-125 |
| Pyzchiva 130 mg/26 ml vial | Ustekinumab-ttwe 130 mg/26 ml |
| Pyzchiva 45 mg/0.5 ml Syringe | Ustekinumab-ttwe 45 mg/0.5 ml |
| Pyzchiva 45 mg/0.5 ml Syringe | Ustekinumab-ttwe 45 mg/0.5 ml |
| Pyzchiva 90 mg/ml Syringe | Ustekinumab-ttwe 90 mg/ml |
| Pyzchiva 45 mg/0.5 ml Vial | Ustekinumab-ttwe 45 mg/0.5 ml Vial |
| Qudexy XR 150 mg Capsule | Topiramate ER 150 mg Sprinkle Cap |
| Qudexy XR 200 mg Capsule | Topiramate ER 200 mg Sprinkle Cap |
| Restasis 0.05% Eye Emulsion | Cyclosporine 0.05% Eye Emulsion |
| Sabril 500 mg Tablet | Vigabatrin 500 mg Tablet |
| Spiriva Handihaler 18 mcg Cap | Tiotropium 18 mcg Cap-Inhaler |
| Suboxone 12-3 mg Film | Buprenorphine/Naloxone 12-3 mg Film |
| Suboxone 2-0.5 mg Film | Buprenorphine/Naloxone 2-0.5 mg Film |
| Suboxone 4-1 mg Film | Buprenorphine/Naloxone 4-1 mg Film |
| Suboxone 8 mg-2 mg Film | Buprenorphine/Naloxone 8mg-2mg Film |
| Symbicort 160-4.5 mcg Inhaler | Budesonide-Formoterol 160-4.5 mcg Inhaler |
| Symbicort 80-4.5 mcg Inhaler | Budesonide-Formoterol 80-4.5 mcg Inhaler |
| Tekturna 150 mg Tablet | Aliskiren 150 mg Tablet |
| Tekturna 300 mg Tablet | Aliskiren 300 mg Tablet |
| Tracleer 125 mg Tablet | Bosentan 125 mg tablet |
| Tracleer 62.5 mg Tablet | Bosentan 62.5 mg tablet |
| Travatan Z 0.004% Eye Drop | Travoprost 0.004% Eye Drop |
| Vagifem 10 mcg Vaginal Tab | Estradiol 10 mcg Vaginal Insert |
| Victoza 2-pak 18 mg/3 ml Pen | Liraglutide 18 mg/3 ml Pen |
| Vyvanse 10 mg Cap | Lisdexamfetamine 10 mg Cap |
| Vyvanse 20 mg Cap | Lisdexamfetamine 20 mg Cap |
| Vyvanse 30 mg Cap | Lisdexamfetamine 30 mg Cap |
| Vyvanse 40 mg Cap | Lisdexamfetamine 40 mg Cap |
| Vyvanse 50 mg Cap | Lisdexamfetamine 50 mg Cap |
| Vyvanse 60 mg Cap | Lisdexamfetamine 60 mg Cap |
| Vyvanse 70 mg Cap | Lisdexamfetamine 70 mg Cap |
| Xarelto 2.5 mg Tablet | Rivaroxaban 2.5 mg Tablet |
| Xigduo XR 10mg-1000mg Tablet | Dapagliflozin-Metfor ER 10-1000 Tablet |
| Xigduo XR 5mg-1000mg Tablet | Dapagliflozin-Metfor ER 5-1000 Tablet |
| Xopenex HFA 45 mcg Inhaler | Levalbuterol HFA 45 mcg Inhaler |
When a PDL class has a preferred brand with a non-preferred generic, providers requesting prior approval for the non-preferred generic should give a clinical reason why the beneficiary cannot use the brand.
72-Hour Emergency Supply Available for Pharmacy Prior Authorization Drugs
Pharmacy providers are encouraged to use the 72-hour emergency supply allowed for drugs requiring prior approval. Federal law requires that this emergency supply be available to Medicaid beneficiaries for drugs requiring prior approval (Social Security Act, Section 1927, 42 U.S.C. 1396r-8(d)(5)(B)). Use of this emergency supply will ensure access to medically necessary medications.
The system will bypass the prior approval requirement if an emergency supply is indicated. Use a “3” in the Level of Service field (418-DI) to indicate that the transaction is an emergency fill.
Note: Copayments will apply. There is no limit to the number of times the emergency supply can be used.
Checkwrite Schedule for April 2026
| Electronic Cutoff Schedule | Checkwrite Date |
|---|---|
| April 2, 2026 | April 7, 2026 |
| April 9, 2026 | April 14, 2026 |
| April 16, 2026 | April 21, 2026 |
| April 23, 2026 | April 28, 2026 |
POS claims must be transmitted and completed by 11:59 p.m. on the day of the electronic cutoff date to be included in the next checkwrite.
The 2026 checkwrite schedules for both NC Medicaid and DMH/DPH/ORH can be found under the Quick Links on the right side of the home page.
John Matta, PharmD, MBA
Director of Pharmacy and Ancillary Services,
NC Medicaid
Division of Health Benefits
N.C. Department of Health and Human Services
Rick Paderick, R.Ph.
Pharmacy Director
NCTracks
GDIT
Angela Smith, PharmD, DHA, MHA
Chief Clinical Officer, NC Medicaid
Division of Health Benefits
N.C. Department of Health and Human Services
Janelle White, MD, MHCM
Chief Medical Officer, NC Medicaid
Division of Health Benefits
N.C Department of Health and Human Service
Melanie Bush
Interim Deputy Secretary, NC Medicaid
Division of Health Benefits
N.C. Department of Health and Human Services
Paul Guthery
Executive Account Director
NCTracks
GDIT
Bonnie Williams
Deputy Executive Account Director
NCTracks
GDIT