MedicaidAdministrativeMedium impact
Use of the Pharmacy National Provider Identifier for Point-of-Sale Protocol Claims Ending May 2026
NC Medicaid - NCDHHS·NC · Family Medicine, Internal Medicine, OB-GYN·Pharmacy
Effective date
May 2, 2026
We identified it
Jun 16, 2026
Summary
Starting May 2, 2026, pharmacies can no longer use the pharmacy NPI as the prescriber on Point-of-Sale claims for five categories of North Carolina Medicaid protocol drugs (nicotine replacement, hormonal contraception, prenatal vitamins, glucagon, HIV PEP). Immunizing pharmacists must enroll as NC Medicaid providers to continue billing for these protocol dispensations.
Action Required
By May 1, 2026: Billing team must verify that any immunizing pharmacists billing NC Medicaid for protocol drugs (nicotine replacement therapy, hormonal contraception, prenatal vitamins, glucagon, HIV PEP) are enrolled as NC Medicaid Ordering, Prescribing, or Referring providers. Update contact information to use Prime Therapeutics Call Center (844-620-6116) instead of NCTracks for pharmacy claims issues starting May 2, 2026. Claims using pharmacy NPI as prescriber for these five protocol categories will be denied after May 1, 2026.