Medications can be a useful component of a comprehensive treatment plan for individuals experiencing a mental illness or substance use disorder. 

Alliance is committed to offering information and technical assistance to help ensure that they are prescribed and administered safely and effectively.

This page offers resources for providers regarding medication policies and resources primarily impacting North Carolina Medicaid recipients, as well as uninsured consumers.

New Check for Opioid Drug Interaction

Beginning Oct. 1, 2018, NC Medicaid will introduce a new edit into NCTracks pharmacy claim processing to provide a further check for opioid and benzodiazepine interactions. The new edit will identify a drug interaction for an opioid analgesic or benzodiazepine when it is determined that there is overlapping use of a different opioid or benzodiazepine within the previous 68 days.

Pharmacy claims failing the new check will deny for edit 59290 – SUPPLEMENTAL DRUG-2-DRUG INTERACTION. The edit can be overridden by the dispensing pharmacist with a submission clarification code of ‘10’ after consulting with the prescriber(s) to determine the clinical need for the concurrent use of the opioid and the benzodiazepine.

For additional information on the NC Medicaid commitment to curtail opioid abuse, refer to the “Opioid Criteria Educational Materials” on the Pharmacy Services webpage of the NCTracks provider portal.

Opioid Dependence Dose Edit

Beginning Oct. 1, 2018, a maximum daily dose edit for opioid dependence treatment medications will go into place. The dispensing pharmacist may override the edit at point-of-sale after consulting the prescriber to determine the clinical need for the higher dose. Documentation is to be made in the NCPDP pharmacy system or on the original prescription. Bypassing the edit will require an override (submission clarification code 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit. A prescriber may proactively document the clinical rationale with issuance of the prescription. The concise documentation may provide information about the patient’s situation, history, therapy goals and outcome. Documentation solely of a diagnosis code is not legitimate justification. The adequacy of proactive documentation is the professional judgement of the pharmacist. Questions can be directed to the CSRA Call Center at 866-246-8505.

Medication Maximum Dose Edit Override available
Suboxone and buprenorphine/naloxone 16mg/day up to 24mg/day
Zubsolv 11.4mg/day up to 17.1mg/day
Bunavail 8.4mg/day up to 12.6mg/day
Buprenorphine single ingredient product 16mg/day up to 24mg/day

Naloxone Resource Guide

This guide provides information on about naloxone, the opioid antagonist used to reverse opioid overdoses and prevent opioid overdose deaths. It includes information about insurance (including Medicaid) coverage of naloxone, how to identify individuals who would benefit the most from having naloxone, the different naloxone product formulations available, sources for naloxone for uninsured consumers, as well as patient education tips and links to more helpful information.

Access the NC Naloxone Resource Guide.

DHHS Communications

Other Important Updates

NC Medicaid Pharmacy Updates – May 4, 2018
Clozapine Therapy Survey
NPCC Medicaid Pharmacy Updates
CCWJC Pharmacy Newsletter
Sublocade Added to Preferred Drug List
Pharmacy Agenda-Provider Quality-February 21, 2018
DMA Proposed Policy on BH Medications
Important Information about the STOP Act for NC Medicaid and Health Choice Beneficiaries
NPI Exemption and Concerta PDL
Pharmacy Behavioral Health Clinical Edits
Preferred Drug List-February 2018
Medical and Clinical Directors December Meeting Agenda
Medicaid Pharmacy Updates, December 2017
Prior Approval Criteria for Opioid Analgesics Updated to Comply with the STOP Act

BH Provider PDL Information
Summary of the November 1, 2017 updates to the Medicaid Outpatient Pharmacy Program Preferred Drug List (PDL) that specifically impacts behavioral health providers and their patients.

CCWJC Psychostimulants Provider Letter
Summary of a status change for antihyperkinesis/ADHD medication category based on the November 1, 2017 update of NC Medicaid Preferred Drug List. Preferred long-acting methylphenidate products as of November 1, 2017 are Aptensio® XR, Quillichew® ER Oral,  and Quillivant® XR Suspension. A prior authorization request must be submitted for alternatives.

Provider-Pharm Summary (November 2017) Brands Preferred with NP Generics
Summary of the preferred brands which have non-preferred generics. This is primarily a pharmacy stocking issue as “brand medically necessary” is NOT needed on the face of the prescription.

General Provider Cover Letter Accessing the PDL
This document can help the provider easily navigate the NC Tracks Pharmacy Services web page, especially to access the Medicaid Preferred Drug List. There is also brief background information on the Preferred Drugs List.

Prior Approval Criteria for Opioid Analgesics Provider Information
Per North Carolina’s Opioid Action Plan to reduce opioid addiction and overdose death, the NC Medicaid Prior Approval Criteria for Opioid Analgesics was implemented on August 27, 2017 and is summarized in this document.

NC DMA Opioid Safety DMA Provisions FAQs
Frequently asked questions and their answers regarding Opioid Safety Prior Authorization Revisions implemented by the  North Carolina Division of Medical Assistance.

NC Medicaid Prior Authorization for Opiate Therapy
This document walks the provider through the NC Tracks process to enter a prior authorization if required for an opioid.

Helpful Links

Lock Your Meds NC
Information on how to safely secure and dispose of prescription drugs to keep them out of the wrong hands. The website also helps people identify warning signs of potential drug abuse and lists available resources to get help.
(252) 237-1241

NC Medicaid Pharmacy Program (NC Medicaid/NC Tracks)
Pharmacy home page for NC Tracks/NC Medicaid Pharmacy. Center page includes announcements, recent pharmacy issues, and links to newly released newsletters/bulletins. Left side includes prior authorization criteria and forms. Right side links to the preferred drug list, a searchable (via Control-F command) document.

NaloxoneSaves.org
NC DHHS site that provides information to the public and pharmacy providers about North Carolina’s statewide standing order for naloxone.

Perinatal Substance Use Project
Perinatal Substance Use Project at the Alcohol/Drug Council of North Carolina provides resources on substance use services for North Carolina women who are pregnant or parenting and using substances.
Judith Johnson-Hostler, (800) 688-4232

Medication Help for Individuals

Patient Assistance Programs:

Medication Assistance Program (MAP)
Non-profit organization which provides access to free prescription drugs for uninsured, low-income individuals. Prescription drugs are available through participating pharmaceutical manufacturers.

Durham County Indigent Pharmacy Program Formulary and MAP Formulary

Partnership for Prescription Assistance
Free online program that connects individuals to patient assistance programs and to free and low-cost clinics in their area.

Patient Advocacy Foundation (PAF) Co-Pay Relief Program (CPF)
Provides direct financial assistance to qualified individuals, assisting them with prescription drug co-payments, coinsurances and deductibles. Individual must have insurance and coverage for the medication for which they are seeking financial assistance and their income must fall below the income guidelines, either 300% or 400% or less of the FPL. CPR call counselors work directly with the individual as well as with the provider of care to obtain necessary medical, insurance and income information to advance the application in an expeditious manner. Upon approval, payments are made to the doctor, pharmacy, and individual directly.

Pharmacy, Non-Profit:

NC Med Assist
Non-profit pharmacy program for North Carolina residents that provides FREE access to lifesaving prescription medications, patient support, advocacy and related services to poor, vulnerable, and uninsured North Carolina residents. The pharmacy mails the prescriptions to North Carolina residents who live outside of Mecklenburg County.

Rx Outreach
Non-profit mail order pharmacy in St Louis that ships directly to individuals’ homes. It is available to qualifying individuals and families. Patients can be on Medicaid, Medicare or other health insurance and still receive medications from Rx Outreach. There are no enrollment or membership fees.

Pharmacy Discount Programs:

Blink Health
For-profit company that offers a free app that finds the cheapest price for a drug and locks it in for individuals who can then pay on-line and fill their prescriptions at one of 60,000 pharmacies in the United States.

FamilyWize
A huge consumer group buying service for the uninsured and underinsured. The discounts and savings on medications are provided voluntarily by the more than 61,000 participating pharmacies that have agreed to provide prices similar to what they give large insurance companies and employers.

Good Rx
For-profit company that collects and compares prices and then offers consumers a coupon to get the best rate. The company has information on every FDA approved medication at more than 70,000 US pharmacies (mostly chains). Once the individual finds the best price at a local pharmacy, they can either print a coupon or show it on their smart phone.

NCMS Discount Prescription Drug Card
Touts savings of up to 75% (discounts average roughly 30%) at more than 68,000 national and regional pharmacies. This card can be used as your primary plan and/or it can be used on prescriptions not covered by your insurance plan.

NeedyMeds
Non-profit clearinghouse that provides information on all medical needs, including medications. It collects data on patient assistance programs, drug coupons and rebates, and offers its own drug discount card.



Page last modified: November 9, 2018