Pharmacy and Prescription Benefits
Pharmacy services
AmeriHealth Caritas North Carolina members can get pharmacy benefits. If you need medicine, your health care provider will write you a prescription to take to a participating pharmacy. Find a list of participating pharmacies with the online directory.
Pharmacy benefits
- Continuous glucose monitors (CGM)
- Emergency contraception
- Glucometers
- Insulin and other diabetic supplies (like syringes, test strips, lancets and pen needles)
- Prescription medicines
- Smoking cessation agents, including over-the-counter products
- Some medicines sold without a prescription (also called over-the-counter), like allergy medicines
AmeriHealth Caritas North Carolina covers medicines that are:
- Approved by the U.S. Food and Drug Administration (FDA)
- Medically necessary
- Not excluded by the North Carolina Medicaid program
- Prescribed by a licensed health care professional
You can find out if your medicine is covered using the Medication Lookup Tool on our website.
We work with our enrolled pharmacies to help you get your prescribed medications. You can pick up your prescription at your local pharmacy or request your pharmacy mail or deliver your prescription to your home at no cost to you.
If you have questions, call AmeriHealth Caritas North Carolina Member Services, 24 hours a day, seven days a week, at 1-855-375-8811 (TTY 1-866-209-6421).
Copays
Some members age 21 and older may be required to pay a copay for prescriptions. A copay is a fee you pay when you get certain health care services from a provider or pick up a prescription from a pharmacy.
Your copays if you have Medicaid*
| Service | Your copay |
|---|---|
| Generic and brand prescriptions | $4 for each prescription |
*There are no copays for the following members or services:
- Members under age 21
- Members who are pregnant
- Members receiving hospice care
- Federally recognized tribal members
- North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
- Children in foster care
- People living in an institution who are receiving coverage for cost of care
If you have questions about prescription copays, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).
Limits on medicines
- You can get a maximum 90-day supply of maintenance medicines. Maintenance medicines treat conditions like asthma, high blood pressure and diabetes.
- For most non-maintenance medicines, you can get a 34-day supply, unless your provider has noted otherwise on the prescription.
- You may get an emergency supply of medicine that will cover you for 72 hours while a prior authorization request is pending. You need to ask your pharmacist for the supply.
AmeriHealth Caritas North Carolina covers certain over-the-counter (OTC) medicines and products at your pharmacy. Our Medication Lookup Tool can help you find specific coverage information for these OTC medicines and devices, including:
- OTC medicines like allergy medicines, smoking cessation products and emergency contraceptives
- Vaccines like COVID and seasonal flu
Your pharmacy will fill your prescriptions with the generic version when one is available, unless otherwise noted on the NC Medicaid Preferred Drug List (PDL). Sometimes brand-named medicines are preferred over generic medicines, or you may be required to try one or two preferred medicines before you can be prescribed non-preferred medicines based on North Carolina Medicaid guidelines.
Generic drugs are as good as brand-name drugs. They are approved by the FDA. To be approved, they must have the same active ingredient, strength, and form, and act the same in your body as the brand-name medicine. Generic medicines must be made to the same strict standards as the brand-name medicine. They may have a different color and shape, but these are the only differences.
If you have questions about pharmacy benefits or prescription copays, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).