Pharmacy Services

NC Medicaid Direct Pharmacy Benefit - Operational Transition

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 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 number, all NC Medicaid Direct Point of sale pharmacy claims will be routed to Prime Therapeutics.

All current 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 midnight on Friday, May 1, 2026.  

To support a seamless transition, Prime will maintain the existing BIN and 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.

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. 

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.

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