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Access policy for state-selected model drugs

 

NC Medicaid Cell & Gene Therapies Clinical Coverage Policy No: 1S-13

Amended date: April 1, 2025

To all beneficiaries enrolled in a Prepaid Health Plan (PHP): For questions about benefits and services available on or after implementation, please contact your PHP.

Prior Approval Drug Criteria

Updated August 1, 2025

Prior authorization (PA) is required for certain drugs prescribed to NC Medicaid recipients. Refer to the link below for specific criteria. Providers may submit requests for approval via fax, phone or via the NCTracks secure portal. The portal is the most efficient method for PA processing.