Hurricane Helene is the worst natural disaster to ever hit western North Carolina. The devastation in the area has led to many individuals being displaced from their homes. This includes North Carolina Medicaid beneficiaries who may now be relocated with family or friends in another state.
North Carolina Medicaid is beginning to learn of beneficiaries not being able to get their medications due to either the pharmacy not being enrolled in NC Medicaid or that the drug formulary in their state differs from that of NC.
Please note the following information regarding key steps and information if encountering a NC Medicaid beneficiary displaced by the recent natural disaster:
CMS has approved an expedited enrollment process, where the pharmacy can be enrolled within 24 hours in NC Medicaid, and claims back to September 25, 2024 will be covered. Please see the bulletin link below for details on how to submit for enrollment. Enrollment should be simple and fast.
Please remind the pharmacies that North Carolina's covered drugs should be nearly identical to their state. North Carolina Medicaid has waived prior authorization and the agency is allowing for early refills, by putting in an edit on the claim. Please see the bulletin link below for details. With the disaster edit, the claims will pay.
Please remind the pharmacies of the requirement to dispense prescriptions to Medicaid members, even when the member cannot pay the copay.
Below is a link to the North Carolina Preferred Drug List.
Thank you so much for your help as North Carolinians continue to navigate the complexities of this natural disaster. For pharmacies assisting displaced NC Medicaid beneficiaries, if you have questions or need assistance, please emailMedicaid.benefits@dhhs.nc.gov.
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