Visit NC Tracks Pharmacy Services Announcements to see the latest pharmacy-related communications from NC Medicaid.
Opioid-related
Opioid Dependence Therapy Agents Coverage
New Check for Opioid Drug Interaction (October 2018) NC Medicaid has an edit in NCTracks pharmacy claim processing to provide a further check for opioid and benzodiazepine interactions. This allows identification of a drug interaction for an opioid analgesic or benzodiazepine when it is determined that there is overlapping use of a different opioid or benzodiazepine within the previous 68 days.
- Pharmacy claims failing the check will deny. This denial can be overridden by the dispensing pharmacist after consulting with the prescriber(s) to determine the clinical need for the concurrent use of the opioid and the benzodiazepine.
- For additional information on the NC Medicaid commitment to curtail opioid abuse, refer to the “Opioid Criteria Educational Materials” on the Pharmacy Services webpage of the NCTracks provider portal.
There is a maximum daily dose for opioid dependence treatment medications per the table below. The dispensing pharmacist may override the edit at point-of-sale after consulting the prescriber to determine the clinical need for the higher dose. Documentation is to be made in the NCPDP pharmacy system or on the original prescription. The pharmacist can override this when the prescriber provides a clinical rationale for the therapy issue alerted by the edit. A prescriber may proactively document the clinical rationale with the issuance of the prescription. The concise documentation may provide information about the patient’s situation, history, therapy goals, and outcome. Documentation solely of a diagnosis code is not a legitimate justification. The adequacy of proactive documentation is the professional judgment of the pharmacist. Questions can be directed to the CSRA Call Center at 866-246-8505.
| Medication | Maximum Dose Edit | Override Available |
|---|---|---|
| Suboxone and buprenorphine/naxalone | 16mg/day | up to 24mg/day |
| Zubsolv | 11.4mg/day | up to 17.1mg/day |
| Buprenorphine single ingredient product | 16mg/day | up to 24mg/day |
Initiatives
Resources
CPESN Pharmacy Locator Tool
The Community Pharmacy Enhanced Services Network (CPESN) allows users to search for NC CPESN pharmacies either by location or by the type of enhanced service(s) needed plus location. The tool is intended for use by care managers, providers, hospital discharge planners, and others to locate a CPESN pharmacy in their community to support patients with complex care needs. The CPESN, an open network of over 200 North Carolina pharmacies committed to broadening the availability of medication management resources to our state’s highest-needs population. The goal of the CPESN is to improve quality of care and patient outcomes related to medication use, enhance patients’ overall health trajectory and reduce the total cost of care. Please share this information within your organization. If there are questions about any of this information, please contact Dr. Vera Reinstein, Alliance Pharmacist by email or at (919) 651-8640.
Lock Your Meds NC
Information on how to safely secure and dispose of prescription drugs to keep them out of the wrong hands. The website also helps people identify warning signs of potential drug abuse and lists available resources to get help.
Lock or Dispose – Alliance Opioid Campaign
Naloxone
- NC Naloxone Distribution Kit
- Naloxone Resource Guide for Alliance Health
- NaloxoneSaves.org
- NCDHHS site
LAI Antipsychotic Injection Administration Resources
If your office does not give LAIAs, to find a treatment location that can administer LAIAs, the CPESN locator tool described above can locate pharmacies offering injection services to patients. Alternatively, for aripiprazole long-acting injections (Abilify only, not Aristada injection), local care centers (LCCs) are alternate treatment locations that administer Abilify Maintena and may be more convenient for patients. LCCs may be retail pharmacies, urgent care clinics, dialysis centers, or infusion centers in your neighborhood. For inpatient providers, LCCs help bridge the gap between discharge and the next injection. For outpatient providers, LCCs provide more options for patients by offering convenient locations and flexible times. Visit here for more information and to find an LCC in your area. An LCC may also be willing to administer other LAIAs besides just Abilify Maintena. We’ve also compiled a list of pharmacies that administer LAI antipsychotic injections.
Perinatal Substance Use Project
Call the Perinatal Substance Use Project at the Alcohol/Drug Council of North Carolina provides screening, information and appropriate referrals for women throughout North Carolina who are pregnant or parenting and using substances. Call them at 800-688-4232.
Medication Patient Assistance Programs
Local County Assistance Programs
- Cumberland County (CCMAP) Formulary
- Durham County Indigent Pharmacy Program Formulary and MAP Formulary
- Wake County Pharmacy Support including the Formulary, Wake County labs, and Clozapine Patient Assistance Guide.
- Mecklenburg County has NC MedAssist which has a free pharmacy program (see formulary) and OTC store.
Note: NC Med Assist serves the entire state of North Carolina as a mail-order pharmacy for prescription medication and has Mobile Free Pharmacy events distributing free over-the-counter medicine in different counties throughout the year
Medication Assistance Program (MAP)
Non-profit organization, listed by county, that provides access to free prescription drugs for uninsured, low-income individuals. Prescription drugs are available through participating pharmaceutical manufacturers.
Medicine Assistance Tool
Free online program that connects individuals to patient assistance programs and to free and low-cost clinics in their area.
Patient Advocacy Foundation (PAF) Co-Pay Relief Program (CPF)
Provides direct financial assistance to qualified individuals, assisting them with prescription drug co-payments, coinsurances and deductibles. Individual must have insurance and coverage for the medication for which they are seeking financial assistance and their income must fall below the income guidelines, either 300% or 400% or less of the FPL. CPR call counselors work directly with the individual as well as with the provider of care to obtain necessary medical, insurance and income information to advance the application in an expeditious manner. Upon approval, payments are made to the doctor, pharmacy, and individual directly.
Pharmacy, Non-Profit
- NC Med Assist
- Non-profit pharmacy program for North Carolina residents that provides FREE access to lifesaving prescription medications, patient support, advocacy, and related services to poor, vulnerable, and uninsured North Carolina residents. The pharmacy mails the prescriptions to North Carolina residents who live outside of Mecklenburg County.
- NC Med Assist also has Mobile Free Pharmacy Events to provide adults and children who are low-income and in need with free over-the-counter medicine such as aspirin, children’s cough syrup, allergy medicine and vitamins are just a few items given to families who need assistance. Most events now have pre-ordering available online.
- Rx Outreach
Non-profit mail order pharmacy in St Louis that ships directly to individuals’ homes. It is available to qualifying individuals and families. Patients can be on Medicaid, Medicare or other health insurance and still receive medications from Rx Outreach. There are no enrollment or membership fees.
Pharmacy Discount Programs
Blink Health
For-profit company that offers a free app that finds the cheapest price for a drug and locks it in for individuals who can then pay on-line and fill their prescriptions at one of 60,000 pharmacies in the United States.
Mark Cuban Cost Plus Drugs
Cost Plus Drug Company contracts with a third party supplier to get unfinished prescription drugs. The service carries out the final stage of processing and labeling and takes a 15% profit margin to reduce the costs of prescription medication — essentially cutting out pharmacy middlemen.
FamilyWize
A huge consumer group buying service for the uninsured and underinsured. The discounts and savings on medications are provided voluntarily by the more than 61,000 participating pharmacies that have agreed to provide prices similar to what they give large insurance companies and employers.
Good Rx
For-profit company that collects and compares prices and then offers consumers a coupon to get the best rate. The company has information on every FDA approved medication at more than 70,000 US pharmacies (mostly chains). Once the individual finds the best price at a local pharmacy, they can either print a coupon or show it on their smart phone.
NCMS Discount Prescription Drug Card
Touts savings of up to 75% (discounts average roughly 30%) at more than 68,000 national and regional pharmacies. This card can be used as your primary plan and/or it can be used on prescriptions not covered by your insurance plan.
NeedyMeds
Non-profit clearinghouse that provides information on all medical needs, including medications. It collects data on patient assistance programs, drug coupons and rebates, and offers its own drug discount card.
Major retailers’ prescription discount plans (Independent pharmacies may match these prices.)
