As previously reported in your North Carolina Medical Society (NCMS) Bulletin, the State Health Plan transitioned to a custom, closed Formulary (Drug List) as of Jan. 1, 2017, which means that certain drugs are not covered. As a result, patients who are insured by the Plan may be contacting your office for alternative options for their medications.
Because of some confusion over the new formulary, the state health plan recently sent a letter to patients and providers clarifying the new coverage. Read the letter to providers, and the letter to patients.
As stated in the letter, there is a formulary exclusion exception process available for patients that have a medical necessity to remain on a non-covered drug. The exception process is administered by CVS Caremark®, the Plan’s Pharmacy Benefit Manager. You can request an exception form by calling CVS Caremark Customer Care at 888-321-3124, or find the form on the Plan website at by clicking Pharmacy Benefits under Plans for Active Employees.