The North Carolina Department of Health and Human Services (NCDHHS) has implemented a new Pharmacy Benefit Administrator (PBA) solution for NC Medicaid Direct effective Saturday, May 2, 2026.
NCDHHS has contracted Prime Therapeutics State Government Solutions LLC (Prime Therapeutics) to support pharmacy benefit operations. This transition modernizes pharmacy services and enhances the experience for providers, pharmacies and beneficiaries across North Carolina.
What This Means for Providers
Providers and pharmacies can expect:
- Streamlined pharmacy benefit administration;
- Improved coordination across providers and pharmacies;
- Enhanced access to pharmacy program information;
- More efficient claims processing and prior authorization workflows; and
- Increased transparency across pharmacy operations.
Services Now Available
Prime Therapeutics delivers a comprehensive set of pharmacy benefit services supported by advanced technology. NC Medicaid Direct continues to manage all clinical policies and reimbursement methodologies for Point-of-Sale (POS) pharmacy.
Prime supports:
Formulary management;
Drug rebate administration;
Clinical programs;
POS claims processing;
Drug utilization review;
Prior Authorization administration;
PHP Lock-In Program Oversight;
Reporting and analytics;
Member services; and
Specialty pharmacy support.
Accessing Prime PBA Pharmacy Provider Portal
Providers can access pharmacy benefit information, resources, and tools through the North Carolina Medicaid Enterprise System (MES).
- Select the “PBA Pharmacy Provider Portal” tile from the NC MES[DG3.1][JM3.2] landing page NC MES Portal to access the portal.
- Some information is available without logging in; additional functionality requires secure login
- Training materials, announcements, and operational guidance are available on the portal
Providers should discontinue use of NCTracks pharmacy benefit functionality and transition fully to the PBA Pharmacy Provider Portal.
Accessing Prior Authorization Clinical Criteria
- Providers can access Prior Authorization (PA) clinical criteria through the NC Medicaid Enterprise System (MES) landing page.
- From the MES Landing Page, select Pharmacy Benefit Administrator (PBA) Pharmacy Provider Portal;
- Select Resources, followed by Forms and Documents,
- and finally, PA Clinical Criteria.
Claims Submission Support
For pharmacy claims, prior authorization and portal support for NC Medicaid Direct, providers can contact the Pharmacy Benefit Administrator, Prime Therapeutics:
Pharmacy Help Desk (24/7): 1-844-620-6116
Web Support Hours: Monday-Friday, 8:00 AM to 8:00 PM ET
Fax: 1-866-422-8981
Provider Support and Training
Provider Education Webinars
To support ongoing provider education, NC Medicaid and Prime hosted webinars to review the PBA transition and address frequently asked questions.
| Date | Topic | Meeting Link |
|---|---|---|
| Webinar 1 March 20, 2026 | Overview of the new Prime PBA system for Medicaid Direct Point of Sale Pharmacy. | Watch webinar 1 video |
| Webinar 2 April 20, 2026 | Deeper dive into the PBA for providers, including a demonstration of the Prime Therapeutics system and addressing frequently asked questions. | Watch webinar 2 video |
Additional Training Resources
Providers can continue to access training materials, recorded webinars, and other resources through the PBA Pharmacy Provider Portal under the Resources section. From there, select links to access all available training.
