Pharmacy EPSDT Requests

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the federal law that states Medicaid must provide all medically necessary health care services to Medicaid-eligible children. A service not covered under the NC Medicaid State Plan may be covered for recipients under 21 years of age if the service is listed at 1905(a) of the Social Security Act and if all EPSDT criteria are met.

Requests for pharmacy services under EPSDT are now being processed by NCTracks for dates of service on or after April 1, 2014. DMA has been processing these requests and will continue to do so for dates of service prior to April 1, 2014.

To submit a pharmacy EPSDT request, providers will need to complete two forms, both of which can be found on the NCTracks provider portal. The Non-Covered State Medicaid Plan Services Requisition Form for Recipients under 21 Years Old must be submitted with the Pharmacy PA Standard Drug Request Form, both of which can be found under Drug Request Forms on the Pharmacy Services page. (See link below)

Complete the information on each form and fax to the number on the bottom of the Standard Drug Request Form (855- 710-1969). For any questions, please contact the Pharmacy PA Department at 1-866-246-8505.