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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. Take it to one of our pharmacies.

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
Physicians
Outpatient services
Podiatrists
$3 per visit
Generic and brand prescriptions $3 for each prescription
Chiropractic
Optical services/supplies
$2 per visit
Optometrists
Non-emergency Emergency Department visits
$3 per visit

*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
Office visit $0 per visit
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
$10 per visit

If you do pay an annual enrollment fee for your child or children:

Service Your copay
Office visit
Outpatient hospital
$5 per visit
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
Non-emergency Emergency Department visits $25 per visit