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NC Department of Health and Human Services
NC Division of
Medical Assistance

Enhanced Specialty Discount on Single-Source Specialty Drugs

Effective with date of service October 10, 2008, the N.C. Medicaid Outpatient Pharmacy Program will utilize a State-determined upper payment limit for select single-source specialty drugs that cost in excess of $1,500 per month.  This is in compliance with a N.C. General Assembly mandate in Session Law 2008-107, Section 10.10(e).  Specialty drugs in the following therapy categories will be affected:

  • Anemia/neutropenia
  • Anticoagulants
  • Enzyme replacement
  • Growth hormones
  • Hemophilia
  • Hepatitis
  • HIV
  • Hyperparathyroidism
  • Immune deficiency
  • Immune globulins
  • Immunosuppressives
  • Multiple sclerosis
  • Oncology
  • Osteoporosis
  • Psoriasis
  • Pulmonary
  • Rheumatoid arthritis
  • Other miscellaneous

The list of specialty drugs that are affected by this upper payment limit is updated on a quarterly basis.  Please refer to Enhanced Specialty Pricing (PDF, 46KB) (updated July 2, 2015) for the list of specialty drugs affected by the new upper payment limit. Ready NC Connect NC