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

Outpatient Pharmacy Services

DMA Clinical Policy and Programs, Outpatient Pharmacy
Phone Number 919-855-4300
Fax 919-715-1255

 

IMPORTANT NOTICE

Please follow the guidelines for requesting Hepatitis C medication found at https://nctracks.nc.gov/content/public/providers/pharmacy/pharmacy-announcements/New-PA-Forms-for-Hep-C-drugs-upd.html”.

 

What’s New

 


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Pharmacy Links


Preferred Drug List (PDL)

The N.C. General Assembly [Session Law 2009-451, Sections 10.66(a)-(d)] authorized the establishment of the N.C. Medicaid Preferred Drug List (PDL) (PDF, 443KB) (Updated 04/27/15), which allows N.C. Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates.  All therapeutic drug classes for which the drug manufacturer provides a supplemental rebate are considered for inclusion on the list. Diabetic supplies may also be included on the list.

Prescribers are strongly encouraged to write prescriptions for “preferred” products.  Prescribers may continue to write prescriptions for drugs not on the N.C. Medicaid Preferred Drug List (PDL). However, if a prescriber deems that the patient’s clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request. Prior authorization requirements may be added to additional drugs in the future.

Comments and questions about the N.C. Medicaid Preferred Drug List may be submitted by e-mail to medicaid.pdl@dhhs.nc.gov. Public comments for a proposed clinical policy or proposed changes to the Preferred Drug List (PDL) will only be accepted during the public comment period and must be submitted through the following website: http://www.ncdhhs.gov/dma/mpproposed.

Note: Magellan Medicaid Administration has been contracted to assist with the Drug Utilization Review (DUR) program, and administer both the Federal Medicaid Drug Rebate Program, and the Preferred Drug List supplemental rebate program through the National Medicaid Pooling Initiative (NMPI). The NMPI is a Medicaid-based, multi-state pooling program where the purchasing power of participating state Medicaid programs are pooled to obtain greater supplemental rebates from pharmaceutical manufacturers.


Preferred Drug List Review Panel

In an effort to increase transparency and openness in the process of developing rules and procedures for the Medicaid PDL, DHHS has established a Medicaid PDL Review Panel. More on the PDL Review Panel.


Prior Authorization

Prior authorization is required for certain drugs prescribed to North Carolina Medicaid recipients. Please visit www.nctracks.nc.gov for prior authorization criteria and prior authorization forms for medications covered by Medicaid.


Outpatient Pharmacy Electronic Registration Programs

The North Carolina Medicaid Outpatient Pharmacy Program has implemented electronic programs requiring prescriber registration.  These programs facilitate prior authorization and documentation requirements for select medications.  Functionality of the web based programs ranges from providing information only to online data submission.  The programs and supporting Medicaid and Health Choice policies are found at the following websites/links.

Document for Safety (www.documentforsafety.org)
(A+KIDS, *ASAP, BRANDS and Synagis Programs)
\= * Information program only

Related Policies


Outpatient Pharmacy Policies


Drug Utilization Review (DUR)

Note: Magellan Medicaid Administration has been contracted to assist with the Drug Utilization Review (DUR) program, and administer both the Federal Medicaid Drug Rebate Program, and the Preferred Drug List supplemental rebate program through the National Medicaid Pooling Initiative (NMPI). The NMPI is a Medicaid-based, multi-state pooling program where the purchasing power of participating state Medicaid programs are pooled to obtain greater supplemental rebates from pharmaceutical manufacturers.


Controlled Substances Task Force


Reimbursement


Outpatient Pharmacy Forms


Contacts

  • Phone: 919-855-4300
  • John C. Stancil, Jr. R.Ph, (Pharmacy Director)
  • Jason Swartz, RPh, MBA (Manager, Outpatient Pharmacy Program)
  • Krista Kness, RPh (Clinical Pharmacist, Drug Utilization Review Coordinator)
  • Charlene Sampson, RPh (Lead Pharmacist, Behavioral Pharmacy Management, Synagis Program)
  • Amy Williams-Phelps, PharmD, RPh (Lead Pharmacist, Pharmacy Prior Authorization Program)
  • Desiree Elekwa-Izuakor, Pharm.D, MBA, (Clinical Pharmacist, Physician Drug Program, Lock-In Program)
  • Deidre Alford, CPT Candidate (Administrative Assistant, Outpatient Pharmacy Program)

 

 

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