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NC Division of Medical Assistance |
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Proposed Medicaid Clinical Coverage Policies
Controlled Substances Reporting System (CSRS)
Drug Effectiveness Review Project (DERP) 
List of Excluded Individuals/ Entities (LEIE) from the HHS Office of Inspector General
National Conference of State Legislatures
DMA Clinical Policy and Programs, Outpatient Pharmacy
Phone Number 919-855-4300
Fax 919-715-1255
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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, 371) KB) (revised 11/14/2012), 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.
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 is required for certain drugs prescribed to North Carolina Medicaid recipients. Please see the What's New page on the Enhanced Pharmacy Program Website for prior authorization criteria and prior authorization forms for medications covered by Medicaid.
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
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