The North Carolina State Health Plan is transitioning Pharmacy Benefit Managers from Express Scripts to CVS Caremark as of Jan. 1, 2017. The Plan also will be moving to a custom, closed formulary effective Jan. 1, 2017, which means that some drugs will no longer be covered.
There will be an exceptions process for instances where providers feel it is medically necessary for patients to remain on a non-covered drug. Requests for such exceptions will not be accepted prior to Jan. 1, 2017, so impacted Plan members will need to plan ahead.
In addition to some drugs no longer being covered, some will require prior approval, step therapy and/or be subject to quantity limits. It is important to make sure that prior approval is received before your patient fills their prescription. If your patient requires prior authorization, beginning Jan. 1, 2017, please call 800-294-5979 to request prior authorization.
Early notification will help avoid delays in your patients receiving their medication in a timely manner. The 2017 North Carolina State Health Plan Preferred Drug List is available on the Plan’s website at
Please speak with your patients that have coverage through the State Health Plan and review any impacts to their current prescriptions.