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

Physicians Drug Program

DMA Clinical Policy and Programs
Phone Number (919) 855-4300
Fax (919) 715-1255

The Physician’s Drug Program covers many drugs purchased for use in an outpatient office setting.  Medicaid covers the cost of the drug when it is purchased by the same provider who is administering the drug.

All drugs are not automatically covered in the Physician’s Drug Program.  Drugs and biologicals must be approved by the Food and Drug Administration and reasonable and necessary for the diagnosis/treatment of the illness/injury for which it is administered (according to accepted standards of medical practice).  Experimental drugs or drugs that are for investigational use are not covered by the Medicaid program.

Covered medications include:

  • Injectable drugs
  • Intravenous administrations
  • Chemotherapy
  • Vaccines/Toxoids
  • Immune Globulins
  • Radiopharmaceuticals

Physician Drug Program Clinical Coverage Policies

Additional information about Physician's Drug Program is available in the following publications:

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

Physicians Drug Program Fee Schedules