Medicaid is committed to supporting increased adoption and utilization of the Board of Pharmacy statewide protocols authorized by legislation. As part of this commitment, effective August 1, 2024, immunizing pharmacists began to receive reimbursement for clinical services provided when utilizing the statewide Nicotine Replacement Therapy (NRT) Protocol. This bulletin applies to Medicaid Managed Care and Medicaid Direct. The claim should be submitted using a medical claim and payment will be issued to the pharmacy.

Also in North Carolina, effective September 1, 2024, Medicaid began covering condoms and spermicides as over-the-counter products, through the pharmacy benefit. This coverage applies to both Medicaid Direct and Managed Medicaid Plans. Coverage supports reproductive health care for Medicaid beneficiaries, including prevention of unintended pregnancy and sexually transmitted diseases. Medicaid beneficiaries will be able to obtain condoms and spermicides from pharmacies enrolled in Medicaid with a prescription from a Medicaid-enrolled provider, with no cost sharing responsibility.

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

Gov. Roy Cooper (D) declared a State of Emergency effective August 5, 2024, and it will remain in effect for 30 days. The Order activates the State Emergency Operations Plan and allows for the Department of Transportation and the Department of Public Safety to take the appropriate action to ensure the expeditious movement of utility vehicles to eliminate power outages, vehicles carrying essential supplies such as food, medicine and fuel or transporting livestock, poultry and crops. This order also triggers the Price Gouging Law.

Also in North Carolina, effective August 1, 2024, Medicaid beneficiaries may obtain the over the counter (OTC) oral contraceptive Opill without a prescription and at no cost. While Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment or even a lack of health care providers in the community. Medicaid beneficiaries will be able to get Opill from pharmacies enrolled in Medicaid who will be able to submit the claim for reimbursement. A $5.00 fee will be included in the reimbursement amount paid to the pharmacy. A dispensing fee will not be paid. Beneficiaries are allowed to obtain up to a 3-month supply of Opill with each request, without a prescription, with a maximum of 13 packs per year. Opill is a progestin only contraceptive. Pharmacists should counsel beneficiaries that Opill is most effective when taken once a day at the same time each day.

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

The Controlled Substance Reporting Act requires that gabapentin dispensing be reported by pharmacies. Gabapentin is not a controlled substance (under federal or North Carolina law), but its dispensing must nonetheless be reported to the Controlled Substances

Reporting System (CSRS). The Drug Control Unit of the Department of Health and Human Services administers the CSRS and has provided questions and answers concerning gabapentin reporting. That guidance is found in the “What information must be reported to the CSRS?” frequently asked questions.

Also in North Carolina, the next Board of Pharmacy election is scheduled to begin November 1, 2024. Two positions on the Board will be filled, the Northeastern District seat presently held by Wallace Nelson and the Central District seat presently held by Ashley Duggins. Board staff will hold Q & A sessions for anyone considering running for one of these positions or for anyone wanting more information about Board service. The first session will be on July 31, 2024, at 7:00 pm, Hampton Inn in Rocky Mount. The second info session will be on August 28, 2024, at 7:00 pm, Hampton Inn in Concord. Complete details will be posted and sent out by the Board next week.

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

On July 1, 2024, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (or “Tailored Plans”) are a new kind of Medicaid Managed Care health plan. Tailored Plans cover doctor visits, prescription drugs and services for mental health, substance use, intellectual/developmental disabilities and traumatic brain injury in one plan. Tailored plans will launch statewide starting July 1, 2024. Approximately 200,000 beneficiaries will be enrolled into Tailored Plans. For more detailed information, please review the Fact Sheet: What Providers Need to Know Before Tailored Plan Launch. 

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

The Board of Pharmacy President Andy Bowman has announced that he will be leaving Board service before the end of his term, which opens a vacant position in the Board’s Southeastern District that will expire on April 30, 2026. To be eligible to run for this vacant Southeastern District seat, the candidate must be a pharmacist who holds an active North Carolina license to practice pharmacy and who resides (residential address, not work/practice address) in one of the counties comprising the Southeastern District. Interested pharmacists shall submit the following materials to the Board’s Executive Director, Jay Campbell, by 5:00 pm on April 26. For more information for the soon-to-be vacant Southeastern Board Member position, please visit the Board’s website.  

1. a letter of interest and any written materials the pharmacist wishes the Board to consider; and  
2. the signatures, legibly printed/typed names, and North Carolina pharmacist license numbers of ten (10) other pharmacists residing in the Southeastern District supporting the pharmacist’s candidacy. 

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

North Carolina Drug Control Unit issued an FAQ for dispensing professionals on reporting Gabapentin to the Controlled Substance Reporting System (CSRS) effective March 1. Pharmacists with additional questions should contact the Drug Control Unit. Note that based on a North Carolina Retail Merchants Association amendment, pharmacies are not required to report gabapentin to the CSRS when gabapentin is a component of a compounded prescription that is dispensed in dosages of 100 milligrams or less. 

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

On February 1, 2024, the Board of Pharmacy proposed Notice of Text for new administrative rules concerning emergency closures of pharmacies due to staffing shortages or other issues. Please see Pages 972-973 (PDF Pages 22-23) of the North Carolina Register, Volume 38, Issue 15. The North Carolina Board of Pharmacy will hold a Public Hearing on March 12 at 9:30 am at the North Carolina Board of Pharmacy and will accept written comments until April 1. Written comments may be submitted to Jay Campbell, 6015 Farrington Rd Ste 201, Chapel Hill, NC 27517 or by email to ncboprulemaking@ncbop.org.

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

The Board of Pharmacy will be holding a Pharmacy Compounding Summit on March 6-8 at the Friday Conference Center in Chapel Hill. The agenda and details are available online.

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

Medicaid has been informed that Wellcare and Carolina Complete have experienced an issue with their new PBM (Express Scripts), being set up to pay at 30 days instead of 14 days, resulting in pharmacies not being paid timely.  

Payments for the first week in January are going out in the coming week. Payments for the second and third weeks will be on a 30-day cycle and will come out in mid-February, payments for the fourth week in January will also come out by mid-February. Pharmacies should be “caught up” in mid-February.  

Penalties and interest will be paid in accordance with Section V. H.1.d of the NC PHP Contract. For more information, please see the Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.  

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