Coming Soon to NCTracks Drug Prior Approval and Criteria Updates

Effective October 27, 2019, the prior approval (PA) criteria and/or forms for topical antihistamines, systemic immunomodulators, Entresto and migraine therapy calcitonin gene related inhibitors will be updated.

At the request of NC Medicaid, these changes will be implemented via system updates in the secure portal, as well as in existing paper drug forms and criteria on the public portal. Please see the summary of changes in the lists below.

Criteria Updates:

  • Entresto - new continuation criteria
  • Immunomodulators (electronic forms only)
  • Migraine Therapy: Calcitonin Gene Related Inhibitors
  • Topical Antihistamines

Immunomodulators Form Updates:

  • Ankylosing Spondylitis
  • Crohns Disease (adult and pediatric)
  • Cryopyrin-Associated Periodic Syndromes including Familial Cold Auto-inflammatory Syndrome
  • Cytokine Release Syndrome
  • Giant Cell Arteritis
  • Hidradenitis Suppurativa
  • Non-Infectious Intermediate Posterior Panuveitis
  • Plaque Psoriasis (adult and pediatric)
  • Polyarticular Juvenile Idiopathic Arthritis
  • Psoriatic Arthritis
  • Rheumatoid Arthritis
  • Systemic Onset Juvenile Idiopathic Arthritis
  • Ulcerative Colitis (adult and pediatric)

Other Form Updates:

  • Entresto
  • Migraine Therapy: Calcitonin Gene Related Inhibitors
  • Topical Antihistamines