Pharmacy

Carolina Complete Health covers most prescription medications. Some prescriptions require prior authorization and may have limitations based on age or the amount of medicine prescribed. Carolina Complete Health also covers certain over-the-counter medications with a prescription from a Carolina Complete Health provider.

What Pharmacy Benefits are covered?

Carolina Complete Health covers certain prescription drugs and over-the-counter drugs when prescribed by an Carolina Complete Health provider. The pharmacy program does not cover all drugs. Some drugs require prior authorization and may have limitations on age, dosage or maximum quantities.

Which Drugs are covered?

The Preferred Drug List (PDL) is a list of drugs covered by Carolina Complete Health. Carolina Complete Health works with the State of North Carolina to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail or mail order pharmacies. Carolina Complete Health's PDL is continually evaluated by Pharmacy and Therapeutics Committees to promote the appropriate and cost-effective use of medications. 

To view the Preferred Drug List, visit the Manuals and Forms page.

Pharmacy Clinical Coverage Criteria (Coming soon)

Pharmacy Request for Prior Approval Forms

• Standard Drug Request Form (PDF)
• Austedo (PDF)
• Botox/Dysport/Myyobloc (PDF)
• Cialis (PDF)
• Crinone 8% Gel (PDF)
• Cystic Fibrosis Medications (PDF)
• Dupixent - ASTHMA (PDF)
• Dupixent for Atopic Dermatitis (PDF)
• Emend/Aprepitant (PDF)
• Emflaza (PDF)
• Entresto (PDF)
• Epinephrine Pens (PDF)
• Eucrisa (PDF)
• Exondys 51 (PDF)
• Fasenra (PDF)
• Gocovri (PDF)
• Growth Hormone - Adult 21 Years of Age and Older (PDF)
• Growth Hormone - Children Less than 21 Years of Age (PDF)
• Ingrezza (PDF)
• Juxtapid or Kynamro (PDF) 
• Lidoderm(PDF)
• Lupus Medications (PDF)
• Mavyret - Initial Request Form (PDF)
• Mavyret - Continuation PA Form (PDF)
• Migraine Calcitonin Gene Related Therapy (PDF)
• Monoclonal Antibody Therapy - Xolair (PDF)
• Neonatal Onset: Multi-System Inflammatory Disease - (Kineret) (PDF)
• Non-Steroidal Anti-Inflammatory Drugs including Cox-2 Inhibitors (PDF)
• Nucala (PDF)
• Opioid Analgesic, Long-Acting (PDF)
• Opioid Analgesic, Short-Acting (PDF)
• Opioid Dependence Therapy Agents (PDF)
• Plaque Psoriasis - (Otezla, Cosentyx, Taltz) (PDF)
• Procrit/Epogen/Aranesp (PDF)
• Provigil and Nuvigil (PDF)
• Sedative Hypnotics (PDF)
• Symdeko (PDF)
• Topical Antihistamines (PDF)
• Topical Anti-Inflamatory Medications (PDF)
• Triptans (PDF)
• Vosevi (PDF)
• Vosevi Continuation (PDF)
• Vusion (PDF)

Immunomodulators Temporary Prior Approval Request Forms

• Anklosing Spondylitis (PDF)
• Crohn's Disease (Adult) (PDF)
• Crohn's Disease (Pediatric) (PDF)
• Cryopyrin-Associated Periodic Syndromes including Familial Cold Autoinflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS) (Arcalyst and Ilaris) (PDF)
• Cytokine Release Syndrome (Actemra and Actemra SQ) (PDF)
• Familial Mediterranean Fever (FMF) (PDF)
• Giant Cell Arteritis (Actemra and Actemra SQ) (PDF)
• Hidradenitis Suppurativa (Humira) (PDF)
• Neonatal Onset: Multi-System Infammatory Disease (Kineret) (PDF)
• Non-Infectious Intermediate Posterior Panuveitis (PDF)
• Plaque Psoriasis (Adult) (PDF)
• Plaque Psoriasis (Pediatric) (PDF)
• Polyarticular Juvenile Idiopathic Arthritis (Enbrel, Humira, Actemra SQ, Actemra Infusion, Orencia Infusion and Orencia SQ) (PDF)
• Psoriatic Arthritis (PDF)
• Rheumatoid Arthritis (PDF)
• Systemic Onset Juvenile Idiopathic Arthritis (For Actemra SQ, Actemra Infusion and Ilaris) (PDF)
• Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) (PDF)
• Ulcerative Colitis (Adult) (PDF)
• Ulcerative Colitis (Pediatric) (PDF)

Other Forms

• Beneficiary Psychosocial Readiness - Hepatitis C Treatment (PDF)
• Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years Old (PDF)