Beginning November 1, 2026, controlled substances pharmacy claims billed under Medicaid Direct (Prime Therapeutics), will be denied at the pharmacy point of sale if the prescribing providers have not updated their NCTracks provider enrollment record with active DEA numbers. Additional details can be found in the NC Medicaid Bulletin. This policy change follows identification of providers who are prescribing controlled substances but have not indicated this in their NCTracks enrollment record and have not provided their DEA numbers. Pharmacies may begin seeing increased denials related to this update. North Carolina Medicaid is continuing outreach to impacted providers to encourage them to update their enrollment records ahead of the November 1 deadline.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.