Welcome to the North Carolina Medicaid Pharmacy Portal
Welcome to the Prime Therapeutics Pharmacy Services website for the NC Medicaid Direct pharmacy program. This site is managed by Prime Therapeutics on behalf of NC Medicaid and serves as a centralized source of information for providers supporting NC Medicaid beneficiaries.
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Clarification Regarding Pharmacy Recoupment for Retroactive PHP Enrollment
The NCTracks Operations Center has identified that a letter dated March 1 and April 1, 2026, with the subject line “Pharmacy Recoupment for Retroactive PHP Enrollment” were sent to some enrolled pharmacies containing inaccurate claim information.
BOP Protocol Drugs
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS).
Effective May 2, 2026, North Carolina Medicaid Direct will no longer allow the Pharmacy NPI in the prescriber field on POS claims submitted for the BOP Protocol drugs immunizing pharmacist can dispense. More details are available (here - April 2026 Newsletter: https://medicaid.ncdhhs.gov/april-2026-pharmacy-newsletter/download?attachment).
North Carolina Medicaid Direct PA Criteria Documents
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS).
For providers looking to access the PA criteria documents, you’ll find everything you need under the resources tab. Just select “Forms and Documents,” then “PA Criteria.” You can view the documents directly by Forms And Documents.
North Carolina Medicaid Direct Pharmacy Quick Reference Guide
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS).
For providers looking to access the Quick Reference Guide, you’ll find everything you need under the resources tab. Just select “Forms and Documents,” then “POS Documentation.” More details are available NC Medicaid Direct Pharmacy Quick Reference Guide.
30-day Pharmacy Provider Notice
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS). More details are available NC Medicaid Direct 30 Day Provider Notice.
North Carolina Medicaid Direct Pharmacy Provider Manual
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS).
Prime will administer the Point-of-Sale (POS) system to process pharmacy claim transactions. The POS system will accept pharmacy transactions in the National Council for Prescription Drug Programs (NCPDP) standardized version D.0; lower versions will not be accepted.
The North Carolina Medicaid Direct Pharmacy Provider Manual provides claims submission guidelines for the NCDHHS Medicaid Direct program administered by Prime to include important plan coverage and reimbursement policies. More details are available NC Medicaid Direct Pharmacy Provider Manual.
60-day Pharmacy Provider Notice
Beginning May 2, 2026, Prime Therapeutics State Government Solutions LLC (Prime) will serve as the Pharmacy Benefit Administrator (PBA) for the North Carolina Medicaid Direct program administered by the North Carolina Department of Health and Human Services (NCDHHS). More details are available NC Medicaid Direct 60 Day Provider Notice.
Payer Specification
Payer Specification sheet is available online. The payer sheet will detail required claim submission fields and specifications to assist with proper claim filing. Pharmacies are encouraged to coordinate with their software vendor to ensure they are informed of the upcoming transition.
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You can download the latest clinical criteria, PA forms, notifications, and plan guidance