Medicaid Bulletin

SPECIAL BULLETIN COVID-19 #70: Addition of Mailing and Delivery Fees to Retail Pharmacy Claims

Thursday, April 30, 2020

Effective April 27, 2020, prescriptions for NC Medicaid and NC Health Choice beneficiaries are eligible for the addition of a mailing or delivery fee via the guidelines below. NC Medicaid encourages beneficiaries to request, and pharmacy providers to mail or deliver prescriptions to beneficiaries, during the COVID-19 pandemic to achieve better social distancing within their community.

SPECIAL BULLETIN COVID-19 #12: Suspension of Pharmacy POS Adult and Pediatric Behavioral Health Clinical Edits

Tuesday, March 24, 2020

The Outpatient Pharmacy point of sale (POS) adult and pediatric clinical edits for behavioral health medications will temporarily suspend effective March 23, 2020. These point of sale edits target dosages exceeding the FDA approved maximum limit and in class therapeutic duplication.  

Pharmacy Reimbursement Methodology Changes

Wednesday, April 18, 2018

On July 21, 2017, the Centers for Medicare & Medicaid Services notified North Carolina Medicaid that its State Plan Amendment (SPA TN17-0003) had been reviewed and was approved effective April 1, 2017.

Upcoming Changes to the Roche Rebate Program for Preferred Roche Diabetic Supplies

Monday, March 5, 2018

Beginning April 1, 2018, diabetic testing supplies will be transitioned to the North Carolina Medicaid and NC Health Choice Preferred Drug List and Roche diabetic testing supplies will remain preferred.

Updates to Pharmacy Prior Approval Submissions

Monday, February 5, 2018

On Jan. 28, 2018, the NC Department of Health and Human Services (DHHS) implemented updates to NCTracks pharmacy prior approval (PA) requests for North Carolina Medicaid and NC Health Choice beneficiaries.

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Articles beginning January 2018 are available in the blog format.

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