Proposed Medicaid and NC Health Choice Policies


NCGS §108A-54.2 requires that the Department of Health and Human Services consult with and seek the advice of the North Carolina Physician Advisory Group and other professional societies and organizations in developing new or amended Medicaid clinical coverage policies. The law requires the Department to publish proposed new and amended clinical coverage policies on the Department's website and accept oral and written comments. All consultations and comments are considered. The Department has delegated to the Division of Health Benefits Division Director the authority to make the final decisions regarding clinical coverage policies.

Comments submitted to this website may be considered public record and may be disclosed to parties requesting such records, including the identifiable information that you provide in your comment.  You may submit your comment without providing any identifiable information.  Voluntarily providing identifiable information does not mean that you will be contacted about your comment.

The following proposed new or amended Medicaid and NC Health Choice clinical coverage policies are available for review. Comments on proposed polices may be submitted by clicking the email link next to each proposed policy. Comments and questions not specifically related to the proposed policy should not be sent to this Web address. The initial comment period for each proposed policy is 45 days. An additional 15-day comment period follows if a proposed policy is modified as a result of the initial comment period. If the adoption of a new or amended medical coverage policy is necessitated by an act of the General Assembly or a change in federal law, then the 45- and 15-day time periods shall instead be 30- and 10-day time periods.

Proposed Policy Date Posted Submit Comments

Comment Period Ends

Outpatient Pharmacy Prior Approval Criteria Gocovri, Osmolex ER, and Inbrija 3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Antimigraine Agents  3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Xifaxan  3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Pulmozyme  3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Sickle Cell Anemia Agents  3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Arikayce  3/20/20 medicaid.public.comments@dhhs.nc.gov 5/4/2020
Outpatient Pharmacy Prior Approval Criteria Hepatitis C Virus Medications  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Acthar Gel  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Antinarcolepsy/Antihyperkinesis Agents  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Exondys 51 and Vyondys  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Gattex  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Growth Hormones  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Patient Pharmacy Prior Approval Criteria Systemic Immunomodulators  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020
Outpatient Pharmacy Prior Approval Criteria Juxtapid® (lomitapide)  3/19/2020 medicaid.public.comments@dhhs.nc.gov 5/3/2020