Pharmacy Professional Claims for Vaccines Exempt from Co-Pay and Ordering Provider

A change was implemented in NCTracks on December 1, 2016, to exempt pharmacy professional claims for vaccines from co-pay. Co-pays should not be charged on vaccines administered by pharmacists. The exemption from co-pay is effective with date of service January 1, 2016.

In addition, on December 5, 2016, a change was implemented in NCTracks to exempt pharmacy professional claims from the requirement for an Ordering Provider. (Pharmacy claims might have previously pended with Explanation of Benefits 02438 - ORDERING PROVIDER IS REQUIRED FOR THIS SERVICE.)  This change allows immunizing pharmacists to screen and offer appropriately allowed vaccination(s) to Medicaid beneficiaries without obtaining a prescription or an order for that beneficiary or vaccination(s). Immunizing pharmacists are reminded that G.S. 90-85.15B requires pharmacist administered vaccines to be administered under a written protocol and in accordance with a supervising physician licensed in and has a practice physically located in NC. The exemption from the Ordering Provider requirement is effective with date of service November 1, 2016.