Hurricane Florence and Pharmacy Prior Authorization (PA) Overrides

North Carolina Governor Cooper has declared a state of emergency for North Carolina in anticipation of potential severe weather caused by the approach of Hurricane Florence. See the NC declaration of a state of emergency here.

The potential for severe weather conditions may present situations where North Carolina Medicaid and Health Choice beneficiaries in impacted areas may require an early refill of their medications or medications that require prior authorization. The Centers for Medicare and Medicaid Services (CMS) has granted waiver authority for North Carolina Medicaid to allow for the following:

1. Early refill of all covered medications beginning Tuesday, September 11th through Friday, September 21st.
2. Waive prior authorization requirements for all covered medications beginning Friday, September 14th through Friday, September 21st.

In both situations, NC Medicaid enrolled pharmacy providers may resubmit these pharmacy claims with “09” (Emergency Preparedness) in the PA Type Code field.  Do not place any values in the Submission Clarification Code field.

After Hurricane Florence has passed, NC Medicaid will evaluate the need to extend the above waivers and will communicate any changes.