The outpatient pharmacy benefit includes a comprehensive list of prescription drugs, plus certain select OTC products. The outpatient pharmacy benefit also includes the Home Infusion Therapy (HIT) program that covers self-administered infusion therapy, including IV chemotherapy and IV antibiotics.
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).
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.
Disclaimer: For durable medical equipment, medical services, procedures, and nursing visits (including home infusion nursing visits). Please refer to the Medicaid Pre-Auth Tool for more information.
Please use the following resources for coverage details: