Community Care of North Carolina
All Medicaid Beneficiary Antipsychotic Medication Access
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Provider Pharmacy Information
A+KIDS (Antipsychotics-Keeping It Documented for Safety)
This program encourages the use of appropriate baseline and follow-up monitoring parameters to facilitate the safe and effective use of antipsychotics in Medicaid and Health Choice beneficiaries under the age of 18. Providers will be required to document information regarding the efficacy of therapy, side effects, and metabolic monitoring parameters (height/weight/BMI percentile, lipid panel, and blood glucose). Once the information is submitted to the NCTRACKS web-based portal or phoned in successfully, the medication is authorized for 6 months.
ASAP (Adult Safety with Antipsychotic Prescribing)
This program targets off-label prescribing of antipsychotic agents and will include Medicaid eligible adults (age >=18) on atypical (second generation) antipsychotic agents prescribed for an indication that is not approved by the federal Food and Drug Administration. To authorize the prior authorization for APPROVED indications, the prescriber must write in his or her own handwriting “Meets PA Criteria” on the face of each new or renewal antipsychotic prescription or type the phrase in the comment block on e-prescriptions. The authorization period is equivalent to the length of the prescription.
*NOTE* Providers will be required to complete an A+KIDS prior authorization (PA) for any preferred or non-preferred antipsychotic medication in children less than 18 years old. An ASAP authorization will be required for patients older than 18 years, prescribed an antipsychotic for a non-FDA approved use. In addition, there will be a PA required for a non-preferred antipsychotic for all Medicaid beneficiaries. Providers will be required to complete required prior authorizations through the NCTracks Provider Portal or by calling CSC at 1-866-246-8505. THERE WILL BE NO FAX FORMS.
This very helpful flow chart describes which program should be accessed to make an antipsychotic medication request and what information is required with each request. Click Here for flow chart.
Synagis
North Carolina Medicaid has implemented an electronic prior approval process to request coverage of Synagis. The electronic prior approval process creates an opportunity for Medicaid to impact the quality of information provided for a Synagis prior approval request. For full information on this program, you may go to the Document for Safety website.
Medicaid Preferred Drug List (PDL)
Click here to access the Preferred Drug List.
Click here to access Prior Authorization Criteria and Prior Authorization Request forms.
Click here for educational documents related to the 2015 NC Medicaid PDL. Updates to these documents will be made as received from the CCNC Central office under the direction of DMA.
"DOC" (Drugs of Choice) Lists are available to guide you to hassle free prescribing. These drugs require NO Prior Authorization (PA) and are considered 1st tier by most insurance companies. Choose your “Doc” list from here.
NC Controlled Substance Reporting System
This statewide reporting system was established by North Carolina law to improve the state’s ability to identify people who abuse and misuse prescription drugs classified as Schedule II-V controlled substances (Defined). It is also meant to assist clinicians in identifying and referring for treatment patients misusing controlled substances
Click here for an overview of the CSRS system.
Click here to access instructions and application forms to register to use this reporting system. Please Note that licensed professionals may also register via his/her respective board (NC Medical Board, NC Board of Pharmacy, or NC Board of Nursing.
Click here to access the NC Controlled Substance Reporting System using your Username and Password.
Narcotic Lock-In Program
NC Medicaid has implemented a recipient management lock-in program to support the State’s development of procedures for the control of recipient overutilization of Medicaid benefits. Recipients identified for the program will be restricted to a single prescriber and pharmacy in order to obtain opioid analgesics, benzodiazepines, and certain anxiolytics covered through the NC Medicaid Outpatient Pharmacy Program.
Click here to view the February 2015 Pharmacy Newsletter which outlines the program.
Click here to access an overview of the Lock-In Provider Change Process.