Here are a few things to keep in mind regarding your NC Medicaid pharmacy benefits:
• NC Medicaid has a preferred drug list (PDL) much like other insurance companies. This list is made up of two types of medications: Preferred and Non-preferred. Medicaid will cover all preferred prescription drugs your provider writes for you. However, brand medications and certain non-preferred treatments will require prior approval by your doctor. This means your doctor must file documentation and attempt to get approval before this medication can be covered by Medicaid at your pharmacy. ALL non-preferred medications will require prior approval, which may require you to try other drugs before you can get a non-preferred medication.
• Most generic medications are preferred, which means they will be covered by Medicaid with no extra paperwork required of your doctor and no delay at the pharmacy for you. Using generic medications will provide you the same benefit as a brand name drug to treat any condition you may have and, at the same time, will allow financial savings so that Medicaid is able to continue providing important services for you and other patients across the state.
• Prescription copay for recipients ages 20 and under = $0.00
• Prescription copay for recipients ages 21 and older = $3.00
• Prescription copay for pregnant recipients ages 21 and older = $0.00 (restrictions apply)
It is important for you to establish a good relationship with one pharmacy of your choice, especially if you are on multiple medications. Your pharmacy can help you keep track of refills, help you with any insurance prior authorizations and can identify dangerous drug interactions. Your pharmacist is the link between you and your doctor. Taking several medications can be confusing sometimes and not all of your questions may be answered in one doctor visit. Use your pharmacy as a resource to get the help you need to understand your medications, how to take them, and what side effects to possibly expect. YOU need to know about the medications you are taking!
NC Medicaid has implemented a lock-in program for patients receiving a certain number of pain and/or anxiety medications in a 60 day period. If you reach the threshold which qualifies you for this lock-in program, Medicaid will notify you by mail with a letter of instructions. It is important for you to read this letter and take action. Patients must choose one provider and one pharmacy within 30 days of getting a letter in order for Medicaid to cover these pain and/or anxiety medications. If you do not read this letter and choose your doctor and pharmacy for yourself, Medicaid will choose a doctor and pharmacy for you. You will be given the opportunity to make one change per year to your doctor and pharmacy by calling CSC at 1-866-246-8505. If you choose to change your doctor or pharmacy for a second time in that year, you must call CSC to talk about why that change is needed.
If you have questions about your pharmacy benefits, contact the Community Health Partners Pharmacy Desk at 704-874-1944.