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Pharmacy

Carolina Complete Health covers most prescription medications. Some prescriptions require prior authorization and may have limitations based on age or the amount of medicine prescribed. Carolina Complete Health also covers certain over-the-counter medications with a prescription from a Carolina Complete Health provider.

What Pharmacy Benefits are covered?

Carolina Complete Health covers certain prescription drugs and over-the-counter drugs when prescribed by an Carolina Complete Health provider. The pharmacy program does not cover all drugs. Some drugs require prior authorization and may have limitations on age, dosage or maximum quantities.

Which Drugs are covered?

The Preferred Drug List (PDL) is a list of drugs covered by Carolina Complete Health. Carolina Complete Health works with the State of Norch Carolina to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail or mail order pharmacies. Carolina Complete Health's PDL is continually evaluated by Pharmacy and Therapeutics Committees to promote the appropriate and cost-effective use of medications. 

To view the Preferred Drug List, visit the Manuals and Forms page.

You can request a copy of the PDL by calling Member Services at 1-833-552-3876 (TTY: 711).

Specialty Drugs

A specialty drug is a prescription drug that requires special handling, administration or monitoring. These are usually ordered through a specialty pharmacy.

How Do I Get Medications?

You can have your prescriptions filled at a Carolina Complate Health network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription from a Carolina Complete Health prescriber and your Carolina Complete Health ID Card. If you need help finding a pharmacy near you, call us at 1-833-552-3876 (TYY: 711).

Can I Get a Prescription with More Than a 30-day Supply?

As a general rule, Carolina Complete Health members are allowed 30-day supply with the exception of birth control. Carolina Complete Health members are allowed a 90-day supply of birth control.

Where Can I Get My Prescription Filled?

To find a pharmacy that is in the Carolina Complete Health network, you can use the Find a Doctor tool. Type in your city or zip code. Then click Update. Choose Other and type the name of your pharmacy. You can also select the pharmacy type in the Select Specialty area. Only those pharmacies in the Carolina Complete Health network are listed.