Medicaid Bulletin

This guidance is based on products approved by the FDA and recommended by the CDC Advisory Committee on Immunization Practices.

This guidance is based on the NC Immunization Program/Vaccines for Children guidelines.

Wegovy and Zepbound for indications other than weight loss to be covered based on the indications and usage criteria published in the FDA label, pending updated clinical criteria.

Exclusion Sanction questions must be accurately answered on applications and new adverse actions must be reported to the Department.

A psychiatric diagnostic interview (Current Procedural Terminology 90792) may qualify as a Comprehensive Clinical Assessment if it meets all requirements.

This bulletin replaces in full NC Medicaid Rate Reductions – Effective Oct. 1, 2025, published Sept. 25, 2025.

Effective Oct. 1, 2025, NC Medicaid adjusted the provider assessment rates.

Important changes effective Oct. 1, 2025, for providers with any form of license limitation.

The five-year cost of dispensing survey has been completed for North Carolina pharmacies.

Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.