NCTracks
Things to Remember When Submitting Pharmacy PA Requests
Following are some helpful reminders for specific pharmacy prior approval (PA) situations.
1) New Opioid Analgesic PA Forms
Effective August 27, 2017, there are two new opioid analgesic PA request forms that must be used, one for long-acting drugs and one for short-acting drugs. These forms can be found on the Drug Request Forms page of the NCTracks provider portal. The old form has been discontinued and will no longer be accepted. If you submit a PA with the old form, it will be denied.
2) Pharmacy Claim Rejects for “Service Not Covered”
If a recipient is not covered by Medicaid or NC Health Choice (NCHC) for the dates of service on a pharmacy claim, the pharmacy claim will reject with a message “Service Not Covered”. Providers must use the eligibility search function on the secure provider portal to determine if the patient has active Medicaid or NCHC coverage on the dates of service being requested.
3) Prior Approvals For Preferred Medications
The NC DMA Preferred Drug List (PDL) provides direction on which preferred medications require prior approval. When referring to the PDL document, if there is red writing stating that ‘Clinical criteria apply’ or there are step therapy requirements given, PA is required for the preferred medications as well as the non- preferred.
4) Use Preferred Therapies When Possible
Remember to use the Preferred Drug List (PDL) to find preferred alternatives to non-preferred therapies.
Additional Resources
Several additional resources are available to assist pharmacy and medical providers:
New Opioid Educational Resources for Providers
Pharmacy Prior Approval training course
Pharmacy PA for Opioid Analgesics Job Aid
NCTracks Drug Forms page with new opioid PA forms