NC Medicaid Direct Pharmacy Benefit - Operational Transition

NC Medicaid Direct Pharmacy Benefit – Operational Transition

Effective Date: May 2, 2026

Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for NC Medicaid Direct.  NCTracks will no longer process NC Medicaid Direct Point of Sale (POS) Pharmacy claims after Friday, May 1, 2026.

Effective May 2, 2026, Prime will assume responsibility for the existing NC Medicaid Direct BIN and PCN numbers, previously under NCTracks. Since Prime will take over the BIN and PCN numbers, all NC Medicaid Direct Point of Sale Pharmacy claims will be routed to Prime Therapeutics.

All active and historical claims and prior authorizations will be transferred to Prime beginning May 2, 2026. Any claims that need to be reprocessed on or after May 2, 2026, should be submitted to Prime Therapeutics for processing.

 

System Cutover

 NCTracks will no longer process NC Medicaid Direct point-of-sale (POS) pharmacy claims after 11:59 pm on Friday, May 1, 2026.  

To support a seamless transition, Prime will maintain the existing Bank Identification Number (BIN) and Processor Control Number (PCN) currently used by NCTracks. 

  • BIN: 610242
  • PCN: 781640064
  • Group: Not Required

This transition impacts NC Medicaid Direct beneficiaries only.  There is no impact to members enrolled in NC Medicaid Managed Care and Health Plans

Prior Authorization (PA) Submission Changes (Effective May 2, 2026)

Beginning May 2, 2026, providers must no longer use NCTracks to submit, modify, or validate prior authorization (PA) requests for NC Medicaid Direct pharmacy services.

All PA submission, modification, and validation activities for NC Medicaid Direct pharmacy services will transition to Prime Therapeutics system effective May 2, 2026.

Providers should ensure they are prepared to access the Prime PBA – Medicaid Pharmacy Portal through the MES Landing page for all PA-related transactions beginning on this date.

Accessing the PBA Portal

Providers may access the PBA – Medicaid Pharmacy Portal through the NC Medicaid Enterprise System (MES) Landing Page at https://mes.medicaid.ncdhhs.gov/

From the MES Landing Page, select the Pharmacy Provider Portal tile then choose the PBA- Medicaid Pharmacy Portal.  The Medicaid Pharmacy Portal contains announcements, resources, and transition updates. 

Prior to May 2, 2026, providers do not need to select “Login” to view publicly available information on the portal landing page. 

Training materials and educational resources related to the NC Medicaid Direct PBA transition are available on the MES Landing Page.  Additional training opportunities and educational materials will be communicated as they become available. 

Production Claim Submission Requirements (Effective May 2, 2026)

The following claim requirements apply to production claims submitted on or after May 2, 2026, for NC Medicaid Direct.  All claims must be submitted in accordance with the NCPDP Telecommunication Standard Version/Release D.0.

Pharmacy Testing

Pharmacies are strongly encouraged to submit test claims prior to Go-Live to support a smooth transition and confirm system connectivity.

Testing Window

March 16, 2026 – April 17, 2026

Testing Registration

Pharmacies may register for testing prior to the March 16, 2026, testing window.  Early registration is strongly encouraged to allow adequate time for system connectivity validation and issue resolution.

To register for testing and receive test claim details, including test member information, email:

PharmacyTesting@primetherapeutics.com

Please include the following information:

  • Contact Name
  • Telephone Number
  • Pharmacy NPI Number
  • Switch Information

Important Testing Information

Use only the testing BIN (022618) during the testing period.

Do NOT submit any test claims using the production BIN (610242)

Test claims submitted using the production BIN may result in claim rejections or processing errors.

Test claims submitted during the testing window will not adjudicate for payment.

Support and Contact Information

Beginning May 2, 2026, pharmacies may contact the Prime Pharmacy Call Center at 844-620-6116 for assistance with:

  • General pharmacy support
  • Medication dispensing questions
  • System access issues