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 a 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 Preferred Drug List includes drugs you receive at retail pharmacies. Carolina Complete Health adheres to the NC Medicaid Preferred Drug List.

  • The Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d).
    • Prescribers are encouraged to write prescriptions for “preferred” products.
    • Prescribers may continue to write prescriptions for drugs not on the PDL.
    • If a prescriber deems that the patient’s clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request.
    • Prior authorization requirements may be added to additional drugs in the future.
    • Submit Proposed Clinical Policy Changes to the PDL
    • Preferred Drug List Review Panel

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

Pharmacy Clinical Coverage Criteria (Coming soon)

Pharmacy Request for Prior Approval Forms

Immunomodulators Temporary Prior Approval Request Forms

Other Forms