Pharmacy and Prescription Benefits
Pharmacy services
AmeriHealth Caritas North Carolina members can get pharmacy benefits. If you need medicine, your health care provider will write you a prescription.
Pharmacy benefits
- Prescription medicines
- Some medicines sold without a prescription (also called over-the-counter), like allergy medicines
- Insulin and other diabetic supplies (like syringes, test strips, lancets and pen needles)
- Smoking cessation agents, including over-the-counter products
- Emergency contraception
Copays
Some members may be required to pay a copay. A copay is a fee you pay when you get certain health care services from a provider or pick up a prescription from a pharmacy.
Your copays if you have Medicaid*
| Service | Your copay |
|---|---|
| Generic and brand prescriptions | $4 for each prescription |
*There are no copays for the following members or services:
- Members under age 21
- Members who are pregnant
- Members receiving hospice care
- Federally recognized tribal members
- North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
- Children in foster care
- People living in an institution who are receiving coverage for cost of care
Copays if your child has NC Health Choice
If you do not pay an annual enrollment fee for your child or children:
| Service | Your copay |
|---|---|
|
Generic prescription
Brand prescription when no generic is available
Over-the-counter medications
|
$1 for each prescription |
| Brand prescription when generic is available | $3 for each prescription |
If you do pay an annual enrollment fee for your child or children:
| Service | Your copay |
|---|---|
| Generic prescription Brand prescription when no generic is available Over-the-counter medicines |
$1 for each prescription |
| Brand prescription when generic is available | $10 for each prescription |
If you have questions about prescription copays, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).