The North Carolina Department of Health and Human Services (NCDHHS) has awarded a contract to Prime Therapeutics, LLC., to implement a new Pharmacy Benefits Administrator (PBA) solution for NC Medicaid Direct. The PBA will go live on Saturday May 2, 2026, modernizing pharmacy benefit operations across NC Medicaid.
The new PBA will provide a more streamlined approach to administrating pharmacy benefits, facilitating improved communications, and coordination among healthcare providers, pharmacies, and patients. This will enhance efficiency, transparency, and accessibility within the pharmacy network, resulting in improved patient care, cost-effective medication management, and a more seamless experience for all stakeholders.
The PBA administrator (Prime) will deliver a comprehensive set of pharmacy benefit services powered by innovative technology while NCDHHS will continue to manage all clinical policies and reimbursement methodologies for Point-of-Sale Pharmacy. The new PBA will include:
- Formulary management
- Drug rebate administration
- Clinical programs
- Point-of-sale (POS) claims processing
- Drug utilization review
- Prior Authorization administration
- PHP Lock-In Program oversight
- Reporting and analytics
- Member services
- Specialty pharmacy support
Provider Support and Training
Provider Webinars
To support provider readiness, NC Medicaid and Prime will host two provider education webinars in March and April to review the PBA transition and address frequently asked questions.
Upcoming PBA Informational Webinars for Providers
| Date | Time | Location | Topic | Meeting Link |
|---|---|---|---|---|
| March 20 | Noon to 1:30 p.m. ET | Virtual via Microsoft Teams | Overview of the new Prime PBA system for Medicaid Direct Point of Sale Pharmacy | Register here |
| April (week of April 20 -TBD) | TBD | Virtual | Deeper dive into the PBA for providers, including a demonstration of the Prime system and addressing frequently asked questions | Coming soon |
Accessing the PBA Portal
Prior to Go-Live, providers should access the PBA portal via the NC MES Portal for the most current updates, announcements, training materials, and resources.
Before May 2, 2026, providers do not need to click the "LOGIN" button to access the public Pharmacy Benefit Administrator portal page. However, if Providers choose to log in, click on the "PBA – Pharmacy Provider Portal" tile to access the PBA – Medicaid Pharmacy Portal.
Additional guidance, including a Self-Help Guide, will be available on the MES Landing Page under the Library section.
