Skip to Main Content


Important Notice regarding your Pharmacy Benefits

As of January 1, 2024, we will be working with Express Scripts to manage our pharmacy benefits.  You will receive or have already received your updated CCH Member ID Card.


  • Keep using your current ID card until January 1, 2024. Do not use your new card yet – it won’t work before January 1, 2024.


  • Start using your new card on January 1, 2024. You will need the new card to get your prescription drugs. Destroy your old ID card on January 1, 2024.
  •  Make sure your pharmacy is still in our network. You can check this on our Find a Provider online search tool. Or you can call Member Services at 1-833-552-3876 (TTY 711).

Please keep your ID card with you at all times. Think of your ID card as your key to using your benefits. If you have questions, please call Member Services at 1-833-552-3876 (TTY 711).

What Pharmacy Benefits are covered?

Carolina Complete Health covers most prescription medications and over-the-counter drugs when prescribed by a 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 North Carolina to ensure that medications used to treat a variety of conditions and diseases are covered. The Preferred Drug List includes drugs you receive at retail pharmacies. Carolina Complete Health adheres to the NC Medicaid Preferred Drug List.

  • The Preferred Drug List (PDL) allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10.66(a)-(d).
    • Prescribers are encouraged to write prescriptions for “preferred” products.
    • Prescribers may continue to write prescriptions for drugs not on the PDL.
    • If a prescriber deems that the patient’s clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request.
    • Prior authorization requirements may be added to additional drugs in the future.
    • Submit Proposed Clinical Policy Changes to the PDL
    • Preferred Drug List Review Panel

To view the Preferred Drug List, visit the Manuals and Forms page.
To view the Utilization Management Policy, visit the Manuals and Forms page.
To view the Prior Approval Forms, visit the Provider Pharmacy Resources page.

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

Search the Formulary

Use the formulary search tool to find out if your medication is covered by Carolina Complete Health. The tool allows you to search through all brand and generic medications covered on the pharmacy outpatient benefit. These medications may be picked up at an in network pharmacy or sent to your home or provider’s office. Click here to access the formulary search tool.

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 Complete 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 (TTY: 711).

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

Carolina Complete Health members are allowed a 90-day supply of most maintenance medications, such as medicine used to treat high blood pressure, diabetes, high cholesterol pressure, or other chronic conditions. Members are allowed to fill a 365 day supply of birth control. Controlled substances are not eligible for an extended supply.

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 Provider 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.

How can I submit for prescription claim reimbursement?

If you paid out-of-pocket for a covered medication or product with active coverage; you may submit a Medicaid Prescription Claim Reimbursement Form (PDF) with required information. Reimbursement is not guaranteed; claims are subject to plan limitations, exclusions and provisions.

Recent Updates

On October 1, 2023, the below PDL updates will go into effect. Trial and failure of two preferred drugs are required unless only one preferred option is listed or is otherwise indicated. Clinical criteria and prior authorization forms can be found at

April 1, 2024 - Prefered Drug List (PDL) Updates

Beginning March 1, 2024, the following updates will be made to Outpatient Pharmacy Clinical Coverage Criteria and the accompanying prior authorization request forms:

  • Continuous Glucose Monitoring (CGM)
    • Removed the beneficiary requires two (2) or more insulin injections daily and the beneficiary’s insulin treatment regimen requires frequent adjustment based on standard BGM or non-therapeutic CGM testing.
    • Added coverage for gestational diabetes
  • Opioid Dependence Therapy Agents
    • Add Lucemyra
  • Sedative Hypnotics
    • Add Quviviq
    • Remove brand name Intermezzo, remove NC Health Choice
  • Triptans
    • Add Rizafilm
    • Remove NC Health Choice
  • Cystic Fibrosis
    • Age for Trikafta changed to 2 and up and added strengths
    • Age for Kalydeco changed to 1 month and older
    • Age for Orkambi changed from 2 years to 1 year or greater
    • Add Kalydeco 13.4mg granules and Kalydeco 5.8mg granules
    • Add Orkambi 75-94mg granules
  • Hereditary angioedema (HAE)
    • New criteria
  • Camzyos
    • New criteria
  • GLP-1 Receptor Agonists and Combinations          
    • New policy
  • Hematinics
    • Add diagnosis of Sickle Cell Disease with Hemoglobin less than or equal to 10 (for Sickle Cell) for initial and Hemoglobin less than or equal to 11 (for Sickle Cell) continuation.
  • Opioid Analgesics
    • Add Seglentis, tramadol solution,
    • Add Seglentis QL
    • Remove obsolete and/or non-rebateable products
    • Update link to new CDC guidelines
    • Add Prolate
  • SGLT2 Inhibitors and Combinations
    • New criteria
  • Topical Local Anesthetics
    • Separated out criteria for preferred vs non-preferred agents
    • Added step through preferred lidocaine patch for approval of non-preferred agents
    • Added, “or beneficiary has a documented clinical reason that these products cannot be tried.”
    • Remove NC Health Choice
  • Vivjoa
    • New criteria
  • Vowst
    • New criteria
  • Zolgensma
    • Addition of INR testing to baseline testing due to blackbox warning regarding acute liver failure
    • Removed NC Health Choice language

On October 1, 2023, the below PDL updates will go into effect. Trial and failure of two preferred drugs are required unless only one preferred option is listed or is otherwise indicated. Clinical criteria and prior authorization forms can be found at

October 1, 2023 - Prefered Drug List (PDL) Updates