Medicare and Medicaid Information for North Carolina Pharmacists

Check here regularly for the latest information regarding Medicare and Medicaid.


MAY 11, 2015 - From NCTracks / NC Division of Medical Assistance

Attention:  Pharmacists and Prescribers

N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes

Effective June 5, 2015, the N.C. Division of Medical Assistance (DMA) will make changes to the N.C. Medicaid and N.C. Health Choice (NCHC) Preferred Drug List (PDL) showing preferred and non-preferred oral antipsychotic medications. The use of a non-preferred anti-psychotic medication will require the trial and failure of only one (1) preferred anti-psychotic medication or a prior authorization (PA).




INFORMATION FROM NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE REGARDING WAIVER OF CO-PAYS FOR MEDICAID RECIPIENTS.  Board of Pharmacy staff often receive questions about whether and to what extent state and federal law permit a pharmacy to waive co-payments for Medicaid recipients.  Board staff refer such questions (and others concerning North Carolina Medicaid issues) to staff of the North Carolina Division of Medical Assistance (“NCDMA”), which administers the North Carolina Medicaid program.  Pharmacists and pharmacies should note, however, that the NCDMA published an article in the October 2013 edition of the Medicaid Pharmacy Newsletter on the subject of waiving of Medicaid co-payments to provide additional information in light of a new state law that went into effect on October 1, 2013.  North Carolina Session Law 2013-145 ( prohibits waiving of Medicaid co-payments as a regular business practice.  NCDMA’s October newsletter, which contains the article at pages 5-7, may be found here. Pharmacists or pharmacies with additional questions should contact NCDMA for further information.

MONDAY, JUNE 4, 2012

NORTH CAROLINA MEDICAID IMPLEMENTS “BRANDS” PROGRAM.  North Carolina pharmacists should review information about North Carolina Medicaid’s newly implemented “BRANDS” program, which sets new policies concerning the dispensing of name-brand medications to Medicaid beneficiaries:  Click here for more information. Pharmacists with questions about the program should contact the North Carolina Division of Medical Assistance.

MONDAY, APRIL 9, 2012 - Update from the NC Department of Health & Human Services Division of Medical Assistance regarding tamper-resistant prescription pads (click here to read).


SUBSTITUTION OF ROCHE DIABETES SUPPLIES FOR PRODIGY DIABETES SUPPLIES FOR NORTH CAROLINA MEDICAID PATIENTS.  The North Carolina Division of Medical Assistance has designated Roche as its supplier of diabetes supplies for North Carolina Medicaid patients.  Pharmacists have inquired whether a switch from Prodigy products (the prior DMA-approved provider) to Roche products requires a new prescription.  Board staff deems substitution permissible without a new prescription.  Board staff strongly advises pharmacists, however, to counsel patients receiving Roche supplies for the first time to reduce confusion, ensure proper use, and promote good health outcomes. 


CMS ENDS CONTRACT WITH FOX INSURANCE COMPANY DRUG PLAN. In follow-up news concerning problems with Fox Insurance Company’s Medicare Part D Plan, CMS has decided to end its contract with Fox. This decision could impact the 123,000 enrollees. This press release provides more information concerning re-enrollment of patients previously covered by the Fox plan:


Suspension of Fox Insurance’s Medicare Part D Plan. Medicare has suspended Fox Insurance’s Medicare Part D plan. This action may impact several thousand North Carolinians. This press release from the North Carolina Department of Insurance details how the SHIIP program may be able to help some of those affected:


GETTING READY FOR MEDICARE D IN 2010: Information for Pharmacists on Medicare D, provided by Senior PharmAssist & The NC Seniors’ Health Insurance Information Program (SHIIP).


North Carolina Seniors’ Health Insurance Information Program (SHIIP) and Senior PharmAssist Issue Guidance to NC Pharmacists on Medicare Part D Open Enrollment Period.


North Carolina Division of Medical Assistance (Medicaid) Issues Guidance on Retention of Paper Prescriptions and Auditing Procedures (click here to read).


TAMPER-RESISTANT PRESCRIPTION PAD COMPLIANCE - Please see this letter from NC DHHS outlining further DMA guidance to providers regarding the upcoming deadlines for compliance with Federal requirements for tamper resistant prescription pads/paper. Beginning April 1, 2008, all written prescriptions for Medicaid fee-for-service recipients are required to have at least one of the industry recognized security features from one of the three categories of characteristics listed in DMA's September 6, 2007 guidance document. By October 1, 2008, written prescriptions will be required to have one industry recognized security feature from each of the three categories of characteristics to be in compliance with Federal law. Please find additional guidance regarding the requirements at:


Using Medicare Prescription Drug Coverage Before Receiving a Drug Plan Membership Card


Medicare Part D Resource Fact Sheet


Long-Term Care Association Letter HPMS


Subspecialty Groups Letter HPMS


Part D Drugs/Part D Excluded Drugs


Medicare Part D Prescription Drug Plans and Temporary First Fill Policies


CMS Process to Ensure Effective Transition to Medicare Part D Prescription Drug Coverage


Quick Answers to FAQs on Processing Claims for Dual Eligible Beneficiaries


Information to Assist Pharmacists in Completing Pharmacy Transactions


Pharmacy Transition Policies Reminder


For CSR Describing the POS "WellPoint" Process to a Pharmacy



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