Effective November 1, 2023, in preparation for the launch of NC Medicaid Expansion, NC Medicaid will remove all copay requirements for antiretroviral (ARV) medications, which decrease viral load in patients with HIV. This change applies to both NC Medicaid Direct and NC Medicaid Managed Care and covers all FDA-approved ARVs used to treat HIV.
Currently, an eligible Medicaid beneficiary who receives prescribed drugs through the Outpatient Pharmacy benefit is required to pay a $4 copay for each prescription received unless they are exempt for one of the reasons listed in the Outpatient Pharmacy Clinical Coverage Policy No. 9. This change in policy supports public health efforts to reduce the transmission of HIV.