Prior Approval Drugs and Criteria

Prior authorization (PA) is required for certain drugs prescribed to NC Medicaid recipients. Refer to the links 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.

Behavioral Health Clinical Edits Criteria


BH Clinical Edit Resolution:  Submission Clarification Code 10

Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit.

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