Sharing on behalf of NC Medicaid:

Given shortfalls in state funding, effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity, which is an optional benefit for Medicaid programs, will be discontinued.  

NC Medicaid remains committed to the potential of GLP-1s for
the treatment of obesity; however, at this time the lack of funding for the
program prohibits continued coverage for weight management purposes. 

GLP-1s will continue to be covered for the indications of diabetes, reduction in cardiovascular death, heart attack and stroke in obese adults with cardiovascular disease, noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and severe obstructive sleep apnea (OSA). 

What's Changing 

• Effective Oct. 1, 2025, Wegovy, Zepbound and Saxenda will be removed from the Preferred Drug List (PDL) as an off-cycle change.
• Saxenda will no longer be covered for any indication.
• The Non-Incretin Mimetics class of drugs for treatment of obesity will continue to be managed through the PDL. Drugs in the Preferred status on the PDL include: diethylpropion, phendimetrazine and phentermine. These products do not require prior approval.

Coverage of Wegovy and Zepbound will be managed through
prior authorization, using clinical criteria established by the State for the
below Food and Drug Administration (FDA) approved indications.

Click here to see the bulletin from NCDHHS, which applies to NC Medicaid Direct and NC Medicaid Managed Care.

August 11, 2025

Dear Provider,  

Carolina Complete Health is partnering with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for members with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD).  

If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support.  Healthmap’s KHM program integrates into your existing practice workflow to complement your patient’s current plan of care. Healthmap can supply you with actionable information, based on industry proven best practices, and powered by data analytics, to more effectively anticipate and deliver the right clinical care.  

We appreciate your ongoing care for our members. Be on the lookout for outreach from Carolina Complete Health and Healthmap for the introduction to our kidney health management (KHM) program. If you have any questions or concerns, please contact your Provider Engagement Administrator.

Sincerely, Carolina Complete Health 

As part of ongoing system maintenance, Carolina Complete Health's authorization system will be upgraded, requiring a scheduled system outage Friday, Oct. 10, 2025, at 11:00 p.m. EST (10 p.m. CT) through Monday, Oct. 13, 2025, at 8:00 a.m. EST (7 a.m. CT.)

During this scheduled outage, we will be unable to receive authorization requests except as noted below. Please resume submission of your authorization requests on Monday, Oct. 13, 2025.

How to Plan for the Outage:

• Plan accordingly and submit any urgent or time-sensitive authorization requests prior to the scheduled downtime.
• For urgent authorization requests during the outage, call 1-833-837-0188. Of note, this number will only be active during this downtime.
• Beginning on Monday, Oct. 13, 2025 at 8:00 a.m. EST (7 a.m. CT), providers may submit authorization requests as usual. 

If you have questions, please contact your Provider Engagement representative.

We are please to share that effective July 28, 2025, the Carolina Complete Health Standard Plan check run schedule will be updated to Monday, Wednesday and Friday, with payment issued to providers the following business day. Previous check run schedule was weekly on Tuesday and Friday.

Providers can check claim status, view payment history, and access Explanations of Payment (EOPs) using the Carolina Complete Health Secure Provider Portal. 

Please reach out to Provider Services if you have any questions at 1-833-552-3876.