Medicaid will be launching a new Pharmacy Benefit Administrator (PBA) on May 2. As part of this transition, the pharmacy component of NCTracks will be decommissioned and moved to the new PBA operated by Prime Therapeutics. Beginning May 2, the new PBA will process Point-of-Sale pharmacy claims for Medicaid Direct.

The Managed Care Plans will continue to operate as they do today. There is no change to their PBM or Point-of-Sale pharmacy processing. This transition only impacts beneficiaries utilizing Medicaid Direct.

To support a smooth transition, there will be a series of provider education webinars:

1. Provider Webinar #1 (Hosted by Prime): Scheduled for March 20, this session will focus on high-level PBA transition information and include a live system demo from Prime Therapeutics.
2. Provider Webinar #2: Tentatively planned for April 21, this session will provide a deeper dive into operational functions of the Prime PBA and address any hot topics identified during the first webinar.

For more information, visit the PBA website.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The latest Medicaid Pharmacy Newsletter, dated January 2026, is now available on the Medicaid website. In addition to the February 2026 check write schedule, this edition of the newsletter includes the articles: 

• Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies 

• NC Medicaid's Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease 

• North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on Dec. 1, 2025 

• Billing Reminder of a Third-Party Prescription to Medicaid  

• NC Medicaid Reinstitutes Coverage for GLP-1s in Weight Management 

• Coming in May: New Pharmacy Benefits Administrator for NC Medicaid Direct  

 Providers are encouraged to review this important information. The 2026 Medicaid Pharmacy Newsletters can be viewed here.  

Also in North Carolina, the Sales and Use Tax Division of the Department of Revenue (NCDOR)  issued the following guidance on the application and remittance of sales tax as it relates to rounding due to the elimination of the penny. As noted in the guidance, any rounding due to the elimination of the penny should be conducted after the application of sales and use tax and all applicable sales and use tax must be remitted by the retailer to the NCDOR regardless of whether the retailer rounded up or down. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The latest Medicaid Pharmacy Newsletter, dated December 2025, is now available on the Medicaid website. In addition to the January 2026 checkwrite schedule, this edition of the newsletter includes the following articles:

• Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies
• NC Medicaid’s Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease
• Discontinuation of Coverage: Xifaxan (Rifaximin)
• North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on Dec. 1, 2025
• Billing Reminder of a Third-Party Prescription to Medicaid
• NC Medicaid Reinstitutes Coverage for GLP-1s in Weight Management

Also in North Carolina, following the recent announcement of the Rural Health Transformation Program (RHTP) award by CMS, the state reaffirmed its commitment to continue collaboration with a broad coalition of state agencies, rural providers, community partners, academic institutions and the private sector. To advance this collaboration, the Department of Health and Human Services will host a virtual town hall on January 16 to outline program goals, discuss next steps and highlight the anticipated statewide impact. Additional details and registration information will be shared soon. For updates and more information, visit the NC Rural Health Transformation Program webpage.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The latest Medicaid Pharmacy Newsletter, dated November 2025, is now available on the Medicaid website. In addition to the December 2025 check write schedule, this edition of the newsletter includes the following articles: 

• Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT Protocol Reimbursement to Pharmacies 

• Reminder on NC Medicaid Pharmacy Co-payment Requirements 

• NC Medicaid's Participation in Centers for Medicare & Medicaid Services Cell and Gene Therapy Access Model for Sickle Cell Disease 

• Discontinuation of Coverage: Xifaxan (Rifaximin) 

• North Carolina to Launch First-of-its-Kind NC Medicaid Managed Care Plan for Children and Families on December 1, 2025 

• Updates to Coverage for Wegovy and Zepbound for Clinical Indications Other than Weight Loss 

• Immunizing Pharmacist Enrollment and Medical Claims Billing Update 

Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed here.  

Also in North Carolina, effective December 7, the Electronic Funds Transfer (EFT) Attestation will be added to the reverification provider application and to full Manage Change Requests (MCRs) when active electronic funds transfer (EFT) information is present. This attestation requires a signature from the Office Administrator (OA) on the provider's record.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Cost of Dispensing Survey has been completed, and the current Professional Dispensing Fee (PDF) of $10.24 will remain unchanged. While the survey included a review of uncollected copayments, over 85% of participating pharmacy providers did not submit data in response to the copayment-related questions. As a result, this factor did not influence the final determination of the PDF.

Also in North Carolina, the Department of Medicaid recently received questions regarding Medicaid beneficiaries who cannot pay pharmacy copays for medication. A provider cannot refuse to provide services if a beneficiary cannot pay a copay at the time of service. The issue is addressed in Pharmacy Policy 9 under section 5.5 Copayments. An eligible Medicaid beneficiary, who receives prescribed drugs, is required to make a copayment of $4.00 for each prescription received unless they are exempt for one of the reasons listed in Subsection 5.5.2. A provider may not deny services to any Medicaid beneficiary because of the individual’s inability to pay a deductible, coinsurance or copayment amount. A provider may not willfully discount copays for a Medicaid beneficiary, and an individual’s inability to pay does not eliminate his or her liability for the cost sharing charge. The provider shall open an account for the beneficiary, collect the amount owed later and document all attempts to collect the copay.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Dr. Larry Greenblatt, North Carolina Health Director, will rescind the statewide standing order effective October 13. Beginning on that date, pharmacies and pharmacists must revert to the protocols previously used to administer COVID-19 vaccines in the state. Please refer to the North Carolina Board of Pharmacy's guidance regarding CDC/ACIP recommendations and state law governing pharmacy-based COVID-19 vaccine administration. 

Also in North Carolina, the Department of Health and Human Services (NCDHHS) remain committed to transparency, collaboration and fiscal responsibility in administration of the state's Medicaid program. Fee schedules impacted by rate reductions were released October 1, but are subject to change if additional appropriations are made available.  

NC Medicaid provider reimbursement rate reductions are being implemented by the Division of Health Benefits (DHB) to maintain the NC Medicaid program within the current funding allocated to the Medicaid program by the North Carolina General Assembly (NCGA).  

For more information, please see:  

• Medicaid Provider Bulletin article NC Medicaid Rate Reductions – Effective October 1, 2025  

• Oct. 1, 2025, Rate Reduction Questions and Answers  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health and Human Services announced Standing Orders issued by State Health Director Dr. Larry Greenblatt to allow pharmacists at retail locations to test and treat for influenza. Since October 1, pharmacists across the state are able to test for the influenza virus and then immediately treat with the appropriate medications to reduce severity of illness, when appropriate, as authorized under HB 67.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The latest Medicaid Pharmacy Newsletter, dated September 2025, is now available on the NC Medicaid website. In addition to the October 2025 checkwriter schedule, this edition of the newsletter includes the following articles:  

• NC Medicaid to Change Coverage for GLP-1 Weight Management Medications  

• Mailing and Delivery Fees to Retail Pharmacy Claims  

• Reminder: Immunizing Pharmacist Enrollment in NC Medicaid Contraceptives and NRT [Nicotine Replacement Therapy] Protocol Reimbursement to Pharmacies  

• Reminder on NC Medicaid Pharmacy Co-payment Requirements  

• Children and Families Specialty Plan (CFSP) to launch December 1, 2025  

Providers are encouraged to review this important information. The 2025 Medicaid Pharmacy Newsletters can be viewed online.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective Sept. 28, 2025, NCTracks is implementing a new attestation process for Individual and Atypical Individual providers as part of initial enrollment, re-enrollment and reverification applications submitted through the secured provider portal of NCTracks. This change aligns with the National Committee for Quality Assurance (NCQA) standards. 

Also in North Carolina, NCTracks will capture an Individual provider's race, ethnicity, and languages spoken during Individual provider enrollment, re-enrollment, manage change requests, and reverification applications.  

Responses will not be shared outside of the North Carolina Department of Health and Human Services and will be used only for internal purposes. 

For questions, please contact the NCTracks Contact Center at 1-800-688-6696. 

Also in North Carolina, the Board of Pharmacy has published its list of seven pages of rules and determined that every one of these rules are necessary except for some rules dealing with administrative or operational conduct of the Board of Pharmacy. These rules are not being amended but are being readopted, as necessary. The comment period ends for these rules on Thursday, September 11, 2025. Here is a link to all of the rules under review .  

Any person wishing to submit public comments must do so by September 11, 2025. Submit written comments by mail to Jay Campbell, Executive Director, North Carolina Board of Pharmacy, 6015 Farrington Road, Suite 201, Chapel Hill, NC 27517; by fax (919) 246-1056; or by e-mail ncboprulemaking@ncbop.org. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.