Medicaid and Health Choice Preferred Drug List Changes

Effective with a date of service of May 1, 2016, the N.C. Division of Medical Assistance (DMA) changes to the N.C. Medicaid and N.C. Health Choice Preferred Drug List (PDL) will be implemented into NCTracks programming.

Below are highlights of some of the changes:

  • Because Victrelis is no longer manufactured the medication has been removed from the NCHC/Medicaid PDL. The trial and failure of Victrelis is no longer required for Hepatitis C Agents.
  • The Angiotensin II Receptor Blocker Combinations (ex. Exforge) now require a trial and failure of an ACE INHIBITOR – unless contraindicated or history of adverse event - even when using a preferred product.
  • The DPP-IV inhibitors and combinations (ex. Januvia), and the Sodium Glucose Co Transporter 2 Inhibitors and Combinations (ex. Invokana) now require a trial and failure or insufficient response to Metformin (or Metformin containing products) - unless contraindication or history of adverse event – even when using a preferred product.
  • Failure of only Spiriva is required when requesting non preferred COPD agents.
  • The injectable GLP-1 Receptor Agonists (ex. Byetta) now require a trial and failure or insufficient response to Metformin (or Metformin containing products) - unless contraindication or history of adverse event – even when using a preferred product. Children 12 years of age and younger may receive Millipred and Veripred solution (two non-preferred oral Glucocorticoid steroids) without the need for prior authorization.

For more information, see the updated NC Medicaid Preferred Drug List (PDL) on the DMA website.