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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:
The list of specialty drugs that are affected by this upper payment limit will be updated on a quarterly basis. Please refer to Enhanced Specialty Pricing (updated November 9, 2009) for the list of specialty drugs affected by the new upper payment limit.
