Please find here a notice from North Carolina Medicaid to permanently transition to a specific dispensing fee for North Carolina Medicaid based on the Cost-of-Dispensing Study performed every five years. This fee is currently $10.24. Also, included in this notice is North Carolina Medicaid’s decision to allow for more than one dispensing fee per month.
Also in North Carolina, see the Medicaid Special Pharmacy Newsletter providing Revised Procedures for Prior Authorization of palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023 – Coverage starts Oct. 1, 2022.
Finally, effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – 12 years of age and older (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91312 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.
Effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Moderna COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – Booster Dose (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91313 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use. More information.
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB’s Medicaid Bulletin webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.