MedicaidAdministrativeMedium impact
Pharmacy Benefit Administrator: Now Live for NC Medicaid Direct
NC Medicaid - NCDHHS·NC·Pharmacy
Effective date
May 2, 2026
We identified it
Jun 16, 2026
Summary
North Carolina Medicaid Direct has transitioned pharmacy benefit administration to Prime Therapeutics effective May 2, 2026. All prior authorization requests must now be submitted to Prime Therapeutics instead of NCTracks, and providers must use the new PBA Pharmacy Provider Portal for all pharmacy-related activities.
Action Required
By May 2, 2026: Billing team must stop using NCTracks for pharmacy benefit activities and transition to Prime Therapeutics PBA Pharmacy Provider Portal accessible through NC Medicaid Enterprise System (MES) Landing Page. Submit all new prior authorization requests directly to Prime Therapeutics using CoverMyMeds or contact (844) 620-6116. Update staff training to use Submission Clarification Code '13' for 72-hour emergency fills. Continue using existing BIN 610242 and PCN 781640064 for pharmacy claims processing.