Beginning February 1, 2022, the following changes will be made to Outpatient Pharmacy Clinical Coverage Criteria and the accompanying prior authorization request forms:
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.
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.
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.
For the Physican Administered Drug Program (PDP), please click here.
For medical services, procedures and durable medical equipment please refer to the Medicaid Pre-Auth Tool.
For medical services, procedures and durable medical equipment please refer to the Medicaid Pre-Auth Tool.
Pharmacy Prior authorizations can be submitted in 3 ways: