Get An Information Service Of The Division Of Medical Assistance North Carolina Medicaid Pharmacy

If you are in the NC Medicaid Lock-in Program and need to change your selected prescriber due to Hurricane Florence, contact the NCTracks Pharmacy Call Center at 1-866-246-8505 and request a change to another prescriber.

The North Carolina Medicaid Pharmacy Program offers a comprehensive prescription drug benefit, ensuring low-income North Carolinians have access to the medicine they need.

NC Medicaid Managed Care PBMs are the fiscal agent for pharmacy benefits for our managed care plans. For example, they pay pharmacy claims for beneficiaries enrolled in managed care plans, similar to NC Medicaid "POS" vendor for Medicaid Direct. Medicaid Pharmacy Benefit Manager (PBM) ncleg.gov https://webservices.ncleg.gov › ViewDocSiteFile ncleg.gov https://webservices.ncleg.gov › ViewDocSiteFile

The Beneficiary Management Lock-in Program restricts beneficiaries to a single prescriber and pharmacy for controlled substances categorized as opiates or benzodiazepines when one or more of the following criteria are met: a. Benzodiazepines: 10 or more claims in two consecutive months when not medically necessary. b. What Providers Need to Know About Pharmacy - NC Medicaid NC Medicaid (.gov) https://medicaid.ncdhhs.gov › download › attach... NC Medicaid (.gov) https://medicaid.ncdhhs.gov › download › attach... PDF

If you are in the NC Medicaid Lock-in Program and need to change your selected prescriber due to Hurricane Florence, contact the NCTracks Pharmacy Call Center at 1-866-246-8505 and request a change to another prescriber. NC Medicaid Hurricane Florence Response & Recovery NC Medicaid (.gov) https://medicaid.ncdhhs.gov › about-us › nc-medicaid-... NC Medicaid (.gov) https://medicaid.ncdhhs.gov › about-us › nc-medicaid-...

Social Services determines eligibility for several Medical Assistance Programs (¿Qué es Medicaid?) based on a variety of guidelines, primarily in the areas of income, financial resources, living arrangements, and in some cases, medical conditions.

Medicaid has contracted with Magellan as a full-service POS Vendor, with anticipated implementation in summer of 2025. NC Medicaid Managed Care PBMs are the fiscal agent for pharmacy benefits for our managed care plans.

Medicaid Fee for Service. Lock-in programs, sometimes referred to as patient review and restriction programs, require patients considered at risk for misuse of certain drugs to obtain and fill prescriptions from predesignated pharmacies and prescribers. Pharmacy and Provider Lock-in Programs in Medicaid Fee for Service macpac.gov https://.macpac.gov › uploads › 2019/08 › Pharmac... macpac.gov https://.macpac.gov › uploads › 2019/08 › Pharmac...