North Carolina Medicaid policy updates
Track new and updated North Carolina Medicaid policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Ctexli Coverage for Cerebrotendinous Xanthomatosis | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Nov 5, 2026 |
| NC Medicaid Outpatient Pharmacy Prior Approval Criteria: Reblozyl | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 12, 2026 |
| Systemic Immunomodulators—Spevigo | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2025 |
| Elevidys Coverage and Prior Approval | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 20, 2025 |
| GLP-1 Medications for Weight Management | North Carolina Medicaid | Clinical | Bariatric & Obesity Management | Modified | Aug 1, 2024 |
| Camzyos Coverage for Obstructive Hypertrophic Cardiomyopathy | North Carolina Medicaid | Clinical | Cardiology | Modified | Mar 1, 2024 |
| Medicaid Outpatient Pharmacy Prior Approval Criteria: GLP-1 Receptor Agonists and Combinations | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 1, 2024 |
| Outpatient Pharmacy Prior Approval Criteria: SGLT2 Inhibitors and Combinations | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 1, 2024 |
| Vowst Medicaid Outpatient Pharmacy Prior Approval Criteria | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Mar 1, 2024 |
| Leqembi Injection Prior Approval Criteria | North Carolina Medicaid | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2024 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.